Provider Demographics
NPI:1356561534
Name:RABINOVICH, ZINOVIY (DPM)
Entity type:Individual
Prefix:
First Name:ZINOVIY
Middle Name:
Last Name:RABINOVICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3546 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7130
Mailing Address - Country:US
Mailing Address - Phone:847-297-9660
Mailing Address - Fax:847-297-9665
Practice Address - Street 1:3546 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-7130
Practice Address - Country:US
Practice Address - Phone:847-297-9660
Practice Address - Fax:847-297-9665
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005115213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005115Medicaid
IL209595Medicare ID - Type Unspecified
IL016005115Medicaid