Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036106200 | IL |
Y | 111NI0900X | Internist | 036106200 | IL |
N | 207RG0300X | Geriatric Medicine | 036-106200 | IL |
NPI | 1003881699 |
---|---|
Provider Name | Kirill Zhadovich |
First Address | Northbrook, IL 60065-2056 |
Second Address | Niles, IL 60714-3159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 06/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H77545 | (02) | IL |