Provider Demographics
NPI:1609090661
Name:JACK ZOLDAN, MD LTD
Entity Type:Organization
Organization Name:JACK ZOLDAN, MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZOLDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-561-6573
Mailing Address - Street 1:5015 N PAULINA ST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2756
Mailing Address - Country:US
Mailing Address - Phone:773-561-6573
Mailing Address - Fax:773-561-8323
Practice Address - Street 1:5015 N PAULINA ST
Practice Address - Street 2:SUITE 315
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2756
Practice Address - Country:US
Practice Address - Phone:773-561-6573
Practice Address - Fax:773-561-8323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty