Basic Information
| Provider Information | |||||||||
| NPI: | 1851387120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZARET | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 114 W ROCKLAND RD | ||||||||
| Address2: | |||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600482700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473538802 | ||||||||
| FaxNumber: | 8473167086 | ||||||||
| Practice Location | |||||||||
| Address1: | 114 W ROCKLAND RD | ||||||||
| Address2: | |||||||||
| City: | LIBERTYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600482700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8473538802 | ||||||||
| FaxNumber: | 8473167086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0127X | 036-060541 | IL | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 208600000X | 036-060541 | IL | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 036-060541-2 | 05 | IL | MEDICAID |