Provider Demographics
NPI:1528015435
Name:ZOMBOLO, ROBERT J (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:ZOMBOLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 PFINGSTEN RD STE 3100
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1339
Mailing Address - Country:US
Mailing Address - Phone:847-866-7846
Mailing Address - Fax:866-940-9890
Practice Address - Street 1:2180 PFINGSTEN RD STE 3100
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1339
Practice Address - Country:US
Practice Address - Phone:847-866-7846
Practice Address - Fax:866-940-9890
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004703213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004703Medicaid
IL016004703Medicaid
ILK13022Medicare ID - Type Unspecified