Provider Demographics
NPI:1780838599
Name:ZAKUSILO, YEVGENY (LAC, DOM)
Entity Type:Individual
Prefix:MR
First Name:YEVGENY
Middle Name:
Last Name:ZAKUSILO
Suffix:
Gender:M
Credentials:LAC, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4856 N DAMEN AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1995
Mailing Address - Country:US
Mailing Address - Phone:773-271-2991
Mailing Address - Fax:
Practice Address - Street 1:4856 N DAMEN AVE
Practice Address - Street 2:STE 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1995
Practice Address - Country:US
Practice Address - Phone:773-271-2991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198000242171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist