MEDICARE: MOTIVATED MEDICINE, PLLC

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	363LF0000X	Family Nurse Practitioner
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1104473263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTIVATED MEDICINE, PLLC

Provider Business Mailing Address
First Line	:	480 E ROOSEVELT RD STE 105
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3969
Country	:	US
Telephone Number	:	630-492-1965
Fax Number	:	630-492-0933

Provider Business Practice Location Address
First Line	:	480 E ROOSEVELT RD STE 105
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3969
Country	:	US
Telephone Number	:	630-492-1965
Fax Number	:	630-492-0933

Authorized Official
Title or Position	:	DIRECT OWNER
Name	:	DR. SARAH JOY ZIELSDORF
Credential	:	M.D.
Telephone Number	:	630-492-1965

Provider Enumeration Date	:	08/23/2019
Last Update Date	:	11/15/2022

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