Basic Information
| Provider Information | |||||||||
| NPI: | 1386675809 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZISHOLTZ | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 SIERRA DR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461437240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178658988 | ||||||||
| FaxNumber: | 3178598590 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 HEALTH CARE DR | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622461154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186641230 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 01/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 036130871 | IL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | EMTL-2021-026 | GU | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | M-2285 | GU | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036130871 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME94395 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | M-2285 | GU | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036130871 | 05 | IL | MEDICAID | BZ9495892 | 01 | FL | DEA | OTHER | IL5686073 | 01 | IL | MEDICARE PTAN | OTHER |