Basic Information
Provider Information
NPI: 1780779124
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZEBALA
FirstName: LUKAS
MiddleName: PETER
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9600 GROSS POINT RD STE 1200
Address2:  
City: SKOKIE
State: IL
PostalCode: 600761214
CountryCode: US
TelephoneNumber: 8478667846
FaxNumber: 2242515150
Practice Location
Address1: 9600 GROSS POINT RD STE 1200
Address2:  
City: SKOKIE
State: IL
PostalCode: 600761214
CountryCode: US
TelephoneNumber: 8478667846
FaxNumber: 2242515150
Other Information
ProviderEnumerationDate: 10/03/2006
LastUpdateDate: 10/12/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/12/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207XS0117X036136276ILY Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine

No ID Information.


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