Provider Demographics
NPI:1487833489
Name:MERRILL J ZAHTZ MD SC
Entity Type:Organization
Organization Name:MERRILL J ZAHTZ MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MERRILL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZAHTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD, SC
Authorized Official - Phone:773-478-1197
Mailing Address - Street 1:3525 W GRANVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2221
Mailing Address - Country:US
Mailing Address - Phone:773-478-1197
Mailing Address - Fax:
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:SUITE 408
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-316-4744
Practice Address - Fax:847-475-6835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360563631Medicaid
ILC43696Medicare UPIN
IL0360563631Medicaid