Provider Demographics
NPI:1114370517
Name:ZAFER JAWICH MD SC
Entity Type:Organization
Organization Name:ZAFER JAWICH MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZAFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-717-8737
Mailing Address - Street 1:1890 SILVER CROSS BLVD
Mailing Address - Street 2:STE 350
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9524
Mailing Address - Country:US
Mailing Address - Phone:815-717-8737
Mailing Address - Fax:815-717-8699
Practice Address - Street 1:1890 SILVER CROSS BLVD
Practice Address - Street 2:STE 350
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9524
Practice Address - Country:US
Practice Address - Phone:815-717-8737
Practice Address - Fax:815-717-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209274Medicare PIN