Provider Demographics
NPI:1770905804
Name:ZISKO, ESAD
Entity type:Individual
Prefix:
First Name:ESAD
Middle Name:
Last Name:ZISKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 W FARRAGUT AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2477
Mailing Address - Country:US
Mailing Address - Phone:773-293-1342
Mailing Address - Fax:
Practice Address - Street 1:2441 W FARRAGUT AVE APT 3B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2477
Practice Address - Country:US
Practice Address - Phone:773-293-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000402246ZC0007X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No282N00000XHospitalsGeneral Acute Care Hospital