Provider Demographics
NPI:1023060969
Name:ZOST, MICHAEL GERARD (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GERARD
Last Name:ZOST
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 DUNDEE RD STE 1802
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2739
Mailing Address - Country:US
Mailing Address - Phone:847-716-2340
Mailing Address - Fax:847-716-2341
Practice Address - Street 1:666 DUNDEE RD STE 1802
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2739
Practice Address - Country:US
Practice Address - Phone:847-716-2340
Practice Address - Fax:847-716-2341
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL0467979152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0718540001OtherDMERC
IL0718540001OtherDMERC
T36630Medicare UPIN