Provider Demographics
NPI:1992405344
Name:ANDOR, ZACHARY TAYLOR
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:TAYLOR
Last Name:ANDOR
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 1:26W030 MACARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-4503
Mailing Address - Country:US
Mailing Address - Phone:630-768-2664
Mailing Address - Fax:
Practice Address - Street 1:1710 N RANDALL RD STE 300
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9405
Practice Address - Country:US
Practice Address - Phone:847-931-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.009546363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant