Provider Demographics
NPI:1881168250
Name:ZWOLINSKI, RUSSELL KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:KENNETH
Last Name:ZWOLINSKI
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 1:4228 N KENMORE AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1376
Mailing Address - Country:US
Mailing Address - Phone:872-203-3543
Mailing Address - Fax:
Practice Address - Street 1:4228 N KENMORE AVE APT 202
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1376
Practice Address - Country:US
Practice Address - Phone:872-203-3543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG25488OtherUPIN