Provider Demographics
NPI:1366838708
Name:ZACHARIAS, TRESA ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:TRESA
Middle Name:ELIZABETH
Last Name:ZACHARIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:RUSH NEUROLOGY
Mailing Address - Street 2:1725 WEST HARRISON STREET, SUITE 1118
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-942-4500
Mailing Address - Fax:312-942-2380
Practice Address - Street 1:RUSH NEUROLOGY
Practice Address - Street 2:1725 WEST HARRISON STREET, SUITE 1118
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-942-4500
Practice Address - Fax:312-942-2380
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361499542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036149954Medicaid