Provider Demographics
NPI:1114019346
Name:ZACCA, NADIM MICHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:NADIM
Middle Name:MICHELL
Last Name:ZACCA
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 1:6550 FANNIN ST STE 2229
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2709
Mailing Address - Country:US
Mailing Address - Phone:713-795-4059
Mailing Address - Fax:713-795-5732
Practice Address - Street 1:6550 FANNIN ST STE 2229
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2709
Practice Address - Country:US
Practice Address - Phone:713-795-4059
Practice Address - Fax:713-795-5732
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5420174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115444502Medicaid
B27757Medicare UPIN
TX00LA14Medicare PIN