MEDICARE: ZIGMA HOME PHYSICIAN LLC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1396575585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZIGMA HOME PHYSICIAN LLC

Provider Business Mailing Address
First Line	:	2405 BIG WOODS DR
Second Line	:
City	:	BATAVIA
State	:	IL
Zip	:	60510-7650
Country	:	US
Telephone Number	:	567-884-0854
Fax Number	:	224-526-5167

Provider Business Practice Location Address
First Line	:	2405 BIG WOODS DR
Second Line	:
City	:	BATAVIA
State	:	IL
Zip	:	60510-7650
Country	:	US
Telephone Number	:	567-884-0854
Fax Number	:	224-526-5167

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EVILLO M DOMINGO
Credential	:	MD
Telephone Number	:	567-224-0854

Provider Enumeration Date	:	08/03/2024
Last Update Date	:	08/03/2024

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