Provider Demographics
NPI:1205844602
Name:ZALDUENDO, ANTHONY C (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:C
Last Name:ZALDUENDO
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 1:530 NE GLEN OAK AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61637-0001
Mailing Address - Country:US
Mailing Address - Phone:309-655-2000
Mailing Address - Fax:309-655-7869
Practice Address - Street 1:530 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637-0001
Practice Address - Country:US
Practice Address - Phone:309-655-6810
Practice Address - Fax:309-655-4041
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
382228OtherHEALTHLINK
05723077OtherBLUE CROSS GROUP NO.
800850OtherMEDICARE GROUP NO.
098090OtherHEALTH ALLIANCE
CF8519OtherMEDICARE RAILROAD GROUP N
IL01ZUOtherJOHN DEERE
539000Medicare ID - Type UnspecifiedGROUP NUMBER
L69922Medicare PIN
382228OtherHEALTHLINK
800850OtherMEDICARE GROUP NO.