Basic Information
Provider Information
NPI: 1487005351
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZHANG
FirstName: ZI
MiddleName: ROGER
NamePrefix:  
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 120 W 22ND ST
Address2:  
City: OAK BROOK
State: IL
PostalCode: 605231557
CountryCode: US
TelephoneNumber: 6305735000
FaxNumber:  
Practice Location
Address1: 9125 S PULASKI RD
Address2:  
City: EVERGREEN PARK
State: IL
PostalCode: 608051441
CountryCode: US
TelephoneNumber: 7084227715
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/22/2016
LastUpdateDate: 02/28/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/02/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X125068212ILN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RN0300X036159449ILY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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