Provider Demographics
NPI:1508009416
Name:ZEGREAN, ANCA IOANA (MD)
Entity Type:Individual
Prefix:MISS
First Name:ANCA
Middle Name:IOANA
Last Name:ZEGREAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S DESPLAINES ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5500
Mailing Address - Country:US
Mailing Address - Phone:312-654-2720
Mailing Address - Fax:
Practice Address - Street 1:1272 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3936
Practice Address - Country:US
Practice Address - Phone:847-549-7222
Practice Address - Fax:847-549-7260
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25268174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVRE9310001OtherGROUP ORGANIZATION PTAN
WV3810026117Medicaid
WV1295720449OtherGROUP ORGANIZATION NPI
WV4000438000OtherGROUP ORGANIZATION MEDICAID NUMBER
WVWV2871AOtherMEDICARE PTAN