Provider Demographics
NPI:1154325074
Name:ZYGMUNT, KENNETH H (DPM)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:H
Last Name:ZYGMUNT
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 1:552 S WASHINGTON ST
Mailing Address - Street 2:STE 116
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6678
Mailing Address - Country:US
Mailing Address - Phone:630-983-5694
Mailing Address - Fax:630-983-5632
Practice Address - Street 1:552 S WASHINGTON ST
Practice Address - Street 2:STE 116
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6678
Practice Address - Country:US
Practice Address - Phone:630-983-5694
Practice Address - Fax:630-983-5632
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003250213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02230069OtherBLUE CROSS/BLUE SHIELD
T36979Medicare UPIN
IL02230069OtherBLUE CROSS/BLUE SHIELD