Provider Demographics
NPI:1588681175
Name:ZUTSHI, NANCY (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:ZUTSHI
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 1:320 E HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2704
Mailing Address - Country:US
Mailing Address - Phone:618-624-3368
Mailing Address - Fax:618-624-3387
Practice Address - Street 1:1201 RICKER RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-4263
Practice Address - Country:US
Practice Address - Phone:618-548-3194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-066220207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1588681175Medicaid
IL036066220-6Medicaid
IL036066220-8Medicaid
LA7100112310Medicaid
IL036066220-7Medicaid
IL1811135882OtherBCBS
IL036066220Medicaid
MO1588681175Medicaid
IL036066220Medicaid
ILIL1682021Medicare PIN
IL567730005Medicare PIN
IL1811135882OtherBCBS
E35189Medicare UPIN