Provider Demographics
NPI:1396817912
Name:ZAJAC, JACEK (MD)
Entity Type:Individual
Prefix:
First Name:JACEK
Middle Name:
Last Name:ZAJAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2500 S HIGHLAND AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5381
Mailing Address - Country:US
Mailing Address - Phone:630-629-3610
Mailing Address - Fax:630-629-4878
Practice Address - Street 1:2500 S HIGHLAND AVE
Practice Address - Street 2:STE 104
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5381
Practice Address - Country:US
Practice Address - Phone:630-629-3610
Practice Address - Fax:630-629-4878
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2024-02-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL361-07774207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL97111Medicare UPIN