Provider Demographics
NPI:1730111097
Name:ZEROMSKA-CANCELLARO, MONIKA (MD)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:ZEROMSKA-CANCELLARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONIKA
Other - Middle Name:
Other - Last Name:CANCELLARO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2368 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2368
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1700
Practice Address - Country:US
Practice Address - Phone:847-570-2860
Practice Address - Fax:847-570-2910
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-108700207V00000X
IL036108700208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108700Medicaid
I18986Medicare UPIN