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NPI Code Detail

MEDICARE: DR. MARK ANDREW ZIEBA D.D.S.

MEDICARE: DR. MARK ANDREW ZIEBA D.D.S.
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
1122300000XDentist019026507IL

General Provider Information

NPI Number : 1578781647
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK ANDREW ZIEBA D.D.S.
Provider Business Mailing Address
First Line : 2328 W FOSTER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-1826
Country : US
Telephone Number : 773-654-3575
Fax Number :
Provider Business Practice Location Address
First Line : 2829 N LINCOLN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60657-6932
Country : US
Telephone Number : 773-528-8900
Fax Number : 773-528-0831
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2007
Last Update Date : 05/13/2024

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