Provider Demographics
NPI:1689169591
Name:ZIJLSTRA, MICHAEL KERT (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KERT
Last Name:ZIJLSTRA
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE. SUITE 5323
Mailing Address - Street 2:OFFICE OF THE CHIEF RESIDENT
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-6686
Mailing Address - Country:US
Mailing Address - Phone:847-570-2505
Mailing Address - Fax:847-570-2905
Practice Address - Street 1:2650 RIDGE AVE. SUITE 5323
Practice Address - Street 2:OFFICE OF THE CHIEF RESIDENT
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-6686
Practice Address - Country:US
Practice Address - Phone:847-570-2505
Practice Address - Fax:847-570-2905
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125.072046207R00000X
IL036155770207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty