Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 036079322 | IL |
NPI | 1053378364 |
---|---|
Provider Name | Dr. Andrew S. Zelby |
First Address | Westchester, IL 60154-5714 |
Second Address | Westchester, IL 60154-5714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 30/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036079322 | (05) | IL |
140007836 | RR MEDICARE (01) | IL |
5553530001 | DURABLE MEDICAL EQUIPMENT (01) | |
F82674 | (02) |