Provider Demographics
NPI:1043042484
Name:ZETA VISITING PHYSICIAN LLC
Entity type:Organization
Organization Name:ZETA VISITING PHYSICIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:567-224-0949
Mailing Address - Street 1:2405 BIG WOODS DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-7650
Mailing Address - Country:US
Mailing Address - Phone:847-508-9999
Mailing Address - Fax:224-526-5167
Practice Address - Street 1:2405 BIG WOODS DR
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-7650
Practice Address - Country:US
Practice Address - Phone:847-508-9999
Practice Address - Fax:224-526-5167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty