Provider Demographics
NPI:1659556546
Name:KIRILL ZHADOVICH, M.D., S.C.
Entity Type:Organization
Organization Name:KIRILL ZHADOVICH, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRILL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHADOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-825-0800
Mailing Address - Street 1:PO BOX 2056
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-2056
Mailing Address - Country:US
Mailing Address - Phone:847-825-0800
Mailing Address - Fax:
Practice Address - Street 1:7900 N MILWAUKEE AVE
Practice Address - Street 2:SUITE 2-24
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3159
Practice Address - Country:US
Practice Address - Phone:847-825-0800
Practice Address - Fax:847-825-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH77545Medicare UPIN
IL212143Medicare PIN