Provider Demographics
NPI:1821790973
Name:PERBOHNER, ZACHARY JON (MD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JON
Last Name:PERBOHNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 N RACINE AVE UNIT 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-4156
Mailing Address - Country:US
Mailing Address - Phone:847-910-2920
Mailing Address - Fax:
Practice Address - Street 1:809 N RACINE AVE UNIT 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-4156
Practice Address - Country:US
Practice Address - Phone:847-910-2920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program