Provider Demographics
NPI:1558750430
Name:ZESSIS, NICHOLAS ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ROBERT
Last Name:ZESSIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 EAST CHICAGO AVENUE
Mailing Address - Street 2:BOX #152
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2605
Mailing Address - Country:US
Mailing Address - Phone:312-227-0078
Mailing Address - Fax:312-227-9525
Practice Address - Street 1:225 EAST CHICAGO AVENUE
Practice Address - Street 2:BOX #152
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2605
Practice Address - Country:US
Practice Address - Phone:312-227-0078
Practice Address - Fax:312-227-9525
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.148502208000000X
MO2016020251208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics