Provider Demographics
NPI:1740275478
Name:ZDON, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ZDON
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 1:3333 GREEN BAY RD
Mailing Address - Street 2:CHICAGO MEDICAL SCHOOL
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3037
Mailing Address - Country:US
Mailing Address - Phone:847-578-8714
Mailing Address - Fax:847-775-6504
Practice Address - Street 1:1900 HOLLISTER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60064-5284
Practice Address - Country:US
Practice Address - Phone:947-918-9420
Practice Address - Fax:847-918-9494
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-077985Medicaid
IL36-077985Medicaid
ILE30852Medicare UPIN