Provider Demographics
NPI:1144336066
Name:ZERATSKY, ROGER T (DPM)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:T
Last Name:ZERATSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HUEHL RD #13
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2319
Mailing Address - Country:US
Mailing Address - Phone:847-504-5000
Mailing Address - Fax:
Practice Address - Street 1:425 HUEHL RD # 13
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2319
Practice Address - Country:US
Practice Address - Phone:847-504-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI761-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43223300Medicaid
WI864760025Medicare PIN
U67381Medicare UPIN
WI000086386Medicare PIN
WI43223300Medicaid
WI1188330001Medicare NSC
WI43223300Medicaid
WI864860024Medicare PIN
WI864760025Medicare PIN
WI1188330001Medicare NSC
WI864920026Medicare PIN