Basic Information
| Provider Information | |||||||||
| NPI: | 1669458766 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAMBUTO | ||||||||
| FirstName: | DOMENIC | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 BUTTERFIELD RD | ||||||||
| Address2: | 300 | ||||||||
| City: | DOWNERS GROVE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605151050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307252730 | ||||||||
| FaxNumber: | 8442055691 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 ALBANY TPKE | ||||||||
| Address2: | 209 | ||||||||
| City: | CANTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060192547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606934060 | ||||||||
| FaxNumber: | 8606934065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2005 | ||||||||
| LastUpdateDate: | 03/30/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 040223 | CT | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 202K00000X | 040223 | CT | N | Allopathic & Osteopathic Physicians | Phlebology |
ID Information
| ID | Type | State | Issuer | Description | P00918491 | 01 | CT | MEDICARE RAILROAD PIN | OTHER |