| Zeta Visiting Physician Llc | |
|
2405 Big Woods Dr Batavia IL 60510-7650 | |
| (847) 508-9999 | |
| (224) 526-5167 |
| Full Name | Zeta Visiting Physician Llc |
|---|---|
| Speciality | General Practice |
| Location | 2405 Big Woods Dr, Batavia, Illinois |
| Authorized Official Name and Position | Carlo Domingo (MANAGING PARTNER) |
| Authorized Official Contact | 5672240949 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Zeta Visiting Physician Llc 2405 Big Woods Dr Batavia IL 60510-7650 Ph: (847) 508-9999 | Zeta Visiting Physician Llc 2405 Big Woods Dr Batavia IL 60510-7650 Ph: (847) 508-9999 |
| NPI Number | 1043042484 |
|---|---|
| Provider Enumeration Date | 08/15/2024 |
| Last Update Date | 08/15/2024 |
| Medicare PECOS PAC ID | 7416489943 |
|---|---|
| Medicare Enrollment ID | O20241022001806 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043042484 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Evillo Manuel Domingo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770587693 PECOS PAC ID: 7719962737 Enrollment ID: I20160310000772 |
| Provider Name | Eki O Drake |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063910016 PECOS PAC ID: 8325309305 Enrollment ID: I20190812004116 |
| Provider Name | Carlo T Domingo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194251272 PECOS PAC ID: 9537595830 Enrollment ID: I20200205000961 |
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