Provider Demographics
NPI:1003940784
Name:ZAIDE, DENNIS BANEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:BANEZ
Last Name:ZAIDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 E MORELAND BLVD
Mailing Address - Street 2:WESTBROOK PRIMARY CARE AND OB/GYN CLINIC
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-2939
Mailing Address - Country:US
Mailing Address - Phone:262-352-5700
Mailing Address - Fax:262-532-5701
Practice Address - Street 1:2315 E MORELAND BLVD
Practice Address - Street 2:WESTBROOK PRIMARY CARE AND OB/GYN CLINIC
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2939
Practice Address - Country:US
Practice Address - Phone:262-352-5700
Practice Address - Fax:262-532-5701
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53175208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278423800Medicaid
WI1003940784Medicaid
WI680860573Medicare PIN
WI736011541Medicare PIN
FLAG6002Medicare PIN