Provider Demographics
NPI:1003881699
Name:ZHADOVICH, KIRILL (MD)
Entity Type:Individual
Prefix:
First Name:KIRILL
Middle Name:
Last Name:ZHADOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2056
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-2056
Mailing Address - Country:US
Mailing Address - Phone:847-858-7367
Mailing Address - Fax:
Practice Address - Street 1:7900 N MILWAUKEE AVE
Practice Address - Street 2:SUITE 2-24
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3159
Practice Address - Country:US
Practice Address - Phone:847-825-0800
Practice Address - Fax:847-825-0803
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-106200207RG0300X
IL036106200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH77545Medicare UPIN
IL212143Medicare PIN