Provider Demographics
NPI:1114249174
Name:JEROME G ZWIERZYCKI MD SC
Entity Type:Organization
Organization Name:JEROME G ZWIERZYCKI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:G
Authorized Official - Last Name:ZWIERZYCKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-444-0486
Mailing Address - Street 1:420 LAKE COOK RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5646
Mailing Address - Country:US
Mailing Address - Phone:847-444-0486
Mailing Address - Fax:847-444-0487
Practice Address - Street 1:420 LAKE COOK RD
Practice Address - Street 2:SUITE 106
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5646
Practice Address - Country:US
Practice Address - Phone:847-444-0486
Practice Address - Fax:847-444-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-071997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC47136Medicare UPIN
IL206567Medicare PIN