Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | 3650426 | IL |
NPI | 1134227259 |
---|---|
Provider Name | Dr. Charles Zugerman |
First Address | Chicago, IL 60611-2968 |
Second Address | Chicago, IL 60611-1666 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 16/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
031600045 | BLUE CROSS NUMBER (01) | IL |
03650426 | (05) | IL |
363181347 | (02) | IL |