Provider Demographics
NPI:1639139272
Name:ZAMBRANO, CARLOS H (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:H
Last Name:ZAMBRANO
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:PO BOX 8088
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-8088
Mailing Address - Country:US
Mailing Address - Phone:773-486-8820
Mailing Address - Fax:773-486-8823
Practice Address - Street 1:2434 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2942
Practice Address - Country:US
Practice Address - Phone:773-486-8820
Practice Address - Fax:773-486-8823
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098517207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098517Medicaid
IL01636111OtherBLUE CROSS BLUE SHIELD
IL01636111OtherBLUE CROSS BLUE SHIELD
ILK26501Medicare PIN
ILH27829Medicare UPIN