Provider Demographics
NPI:1659435089
Name:JUAN F ZAPATA, M.D. LLC
Entity Type:Organization
Organization Name:JUAN F ZAPATA, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:ZAPATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-930-3642
Mailing Address - Street 1:4959 W BELMONT AVE
Mailing Address - Street 2:SUITE N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4332
Mailing Address - Country:US
Mailing Address - Phone:773-930-3642
Mailing Address - Fax:773-930-3974
Practice Address - Street 1:4959 W BELMONT AVE
Practice Address - Street 2:SUITE N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4332
Practice Address - Country:US
Practice Address - Phone:773-930-3642
Practice Address - Fax:773-930-3974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110036207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DO9541OtherRR MEDICARE
0001636792OtherBCBS OF IL
1184668618OtherNPI
DO9541OtherRR MEDICARE