Provider Demographics
NPI:1871358754
Name:ZHANG, DEREK
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:ZHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RUSH ADULT AND PEDIATRIC PRIMARY CARE
Mailing Address - Street 2:1645 W JACKSON BLVD SUITE 215
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3276
Mailing Address - Country:US
Mailing Address - Phone:312-942-8028
Mailing Address - Fax:
Practice Address - Street 1:RUSH ADULT AND PEDIATRIC PRIMARY CARE
Practice Address - Street 2:1645 W JACKSON BLVD SUITE 215
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3276
Practice Address - Country:US
Practice Address - Phone:312-942-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.084572208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics