Provider Demographics
NPI:1376643650
Name:ZUEHLKE, MARTHA ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:ELLEN
Last Name:ZUEHLKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:842 FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1547
Mailing Address - Country:US
Mailing Address - Phone:312-988-7880
Mailing Address - Fax:708-386-8363
Practice Address - Street 1:645 N MICHIGAN AVE
Practice Address - Street 2:SUITE 820
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2826
Practice Address - Country:US
Practice Address - Phone:312-988-7880
Practice Address - Fax:708-386-8363
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360566572084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036056657Medicaid
IL036056657Medicaid
ILC45737Medicare UPIN