MEDICARE: TINA ZOFAKIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	125053743	IL

General Provider Information

NPI Number	:	1023347135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA ZOFAKIS

Provider Business Mailing Address
First Line	:	3414 WINCHESTER LN
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-5753
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5783 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4722
Country	:	US
Telephone Number	:	773-728-8003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2009
Last Update Date	:	06/24/2010

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