Provider Demographics
NPI:1245206853
Name:ZACOUR, KEVIN A (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:ZACOUR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44273-8864
Mailing Address - Country:US
Mailing Address - Phone:330-769-2941
Mailing Address - Fax:330-769-4804
Practice Address - Street 1:267 CENTER ST
Practice Address - Street 2:
Practice Address - City:SEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44273-8864
Practice Address - Country:US
Practice Address - Phone:330-769-2941
Practice Address - Fax:330-769-4804
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005098L207Q00000X
OH34.003531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017204180007Medicaid
PA024351OtherMEDICARE ID
OH0525462Medicaid
OH4112483OtherMEDICARE ID
PAE00686Medicare UPIN
PA024351OtherMEDICARE ID