Provider Demographics
NPI:1326064536
Name:JAWICH, ZAFER (MD)
Entity Type:Individual
Prefix:
First Name:ZAFER
Middle Name:
Last Name:JAWICH
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 1:1890 SILVER CROSS BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9603
Mailing Address - Country:US
Mailing Address - Phone:815-717-8737
Mailing Address - Fax:815-717-8699
Practice Address - Street 1:1890 SILVER CROSS BLVD STE 350
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9603
Practice Address - Country:US
Practice Address - Phone:815-717-8737
Practice Address - Fax:815-717-8699
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036092398Medicaid
G15945Medicare UPIN
IL209274/K07682Medicare ID - Type Unspecified