=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619204625
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEACE MEDICAL GROUP INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2009
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 234 W CERMAK RD 1ST FLOOR
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60616-4879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-808-0880
-----------------------------------------------------
Fax | 312-808-0840
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 167378
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60616-7378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-808-0880
-----------------------------------------------------
Fax | 312-808-0840
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | MICHELLE YU ZENG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 312-808-0880
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 036123779
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------