Provider Demographics
NPI:1467477257
Name:CARLOS H ZAMBRANO MD LLC
Entity Type:Organization
Organization Name:CARLOS H ZAMBRANO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:H
Authorized Official - Last Name:ZAMBRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-486-8820
Mailing Address - Street 1:PO BOX 8088
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-8088
Mailing Address - Country:US
Mailing Address - Phone:773-486-8820
Mailing Address - Fax:773-486-8823
Practice Address - Street 1:2434 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2942
Practice Address - Country:US
Practice Address - Phone:773-486-8820
Practice Address - Fax:773-486-8823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098517207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001636111OtherBLUE CROSS/BLUE SHIELD
IL615318701OtherUS DEPARTMENT OF LABOR
IL615318700OtherUS DEPARTMENT OF LABOR
IL213308Medicare PIN
IL615318701OtherUS DEPARTMENT OF LABOR