Provider Demographics
NPI:1053489815
Name:ZACH, KARIE N (MD)
Entity Type:Individual
Prefix:DR
First Name:KARIE
Middle Name:N
Last Name:ZACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 W WATERTOWN PLANK RD
Mailing Address - Street 2:SPORTS MEDICINE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3595
Mailing Address - Country:US
Mailing Address - Phone:414-805-7100
Mailing Address - Fax:
Practice Address - Street 1:8700 W WATERTOWN PLANK RD
Practice Address - Street 2:SPORTS MEDICINE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3595
Practice Address - Country:US
Practice Address - Phone:414-805-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51962208100000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1053489815Medicaid
WI1053489815Medicaid