Provider Demographics
NPI:1184116220
Name:PUYRAIMOND ZEMMOUR, DAVID (MD, PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PUYRAIMOND ZEMMOUR
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:ZEMMOUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:924 E 57TH ST
Mailing Address - Street 2:BSLC RM R214
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637
Mailing Address - Country:US
Mailing Address - Phone:773-834-4878
Mailing Address - Fax:
Practice Address - Street 1:924 E 57TH ST
Practice Address - Street 2:BSLC RM R214
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:773-834-4878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.162982207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine