Provider Demographics
NPI:1568451920
Name:ZAPATA, MARIO A (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:A
Last Name:ZAPATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 W INDIAN TRL
Mailing Address - Street 2:STE A
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1568
Mailing Address - Country:US
Mailing Address - Phone:630-907-1414
Mailing Address - Fax:630-907-1919
Practice Address - Street 1:2424 W INDIAN TRL
Practice Address - Street 2:STE A
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1568
Practice Address - Country:US
Practice Address - Phone:630-907-1414
Practice Address - Fax:630-907-1919
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-062898207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-062898Medicaid
IL0451514334OtherBCBS#
IL0727500001Medicare NSC
IL036-062898Medicaid
ILB85372Medicare UPIN
IL390362018Medicare PIN
IL390361019Medicare PIN