Provider Demographics
NPI:1770974776
Name:NZEATA, PRINCE (MD)
Entity type:Individual
Prefix:
First Name:PRINCE
Middle Name:
Last Name:NZEATA
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 1:75 FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:847-535-7157
Mailing Address - Fax:312-694-0655
Practice Address - Street 1:1475 E BELVIDERE RD UNIT 385
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2026
Practice Address - Country:US
Practice Address - Phone:847-535-7157
Practice Address - Fax:312-694-0655
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA284089207Q00000X
IL125070518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine