Provider Demographics
NPI:1689027609
Name:ZASTROW, ADAM (CPO)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ZASTROW
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 SEWARD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-5322
Mailing Address - Country:US
Mailing Address - Phone:224-400-3059
Mailing Address - Fax:
Practice Address - Street 1:834 SEWARD ST APT 1
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-5322
Practice Address - Country:US
Practice Address - Phone:224-400-3059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213000343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist