Provider Demographics
NPI:1538534524
Name:ZELENA, MARTA (PA-C)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:ZELENA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 W CORTEZ ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3540
Mailing Address - Country:US
Mailing Address - Phone:773-504-4642
Mailing Address - Fax:
Practice Address - Street 1:2452 W CORTEZ ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3540
Practice Address - Country:US
Practice Address - Phone:773-504-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.005730363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant