MEDICARE: JODY ZALKIN D.M.D.

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	122300000X	Dentist	019-024029	IL

General Provider Information

NPI Number	:	1316399553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY ZALKIN D.M.D.

Provider Business Mailing Address
First Line	:	1897 CLAVEY RD
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-4373
Country	:	US
Telephone Number	:	847-962-1684
Fax Number	:

Provider Business Practice Location Address
First Line	:	1897 CLAVEY RD
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-4373
Country	:	US
Telephone Number	:	847-962-1684
Fax Number	:

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

Provider Enumeration Date	:	07/12/2016
Last Update Date	:	07/12/2016

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