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General NPI Number Information
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NPI Number | 1881989952
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Entity Type | Individual
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Provider Name | JESSIE AW-ZORETIC M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 225 E CHICAGO AVE RADIOLOGY DEPARTMENT, CHILDREN'S MEMORIAL HOSPITAL
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 312-909-7773
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Fax |
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Provider Business Mailing Address
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Address Line | 225 E CHICAGO AVE RADIOLOGY DEPARTMENT, CHILDREN'S MEMORIAL HOSPITAL
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 312-909-7773
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036.133811
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | 125058348
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | 036.133811
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License Number State | IL
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