Provider Demographics
NPI:1386842847
Name:ALLISON-ZAK LLC
Entity Type:Organization
Organization Name:ALLISON-ZAK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ERTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-684-0123
Mailing Address - Street 1:1415 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2051
Mailing Address - Country:US
Mailing Address - Phone:920-684-0123
Mailing Address - Fax:920-682-7374
Practice Address - Street 1:1415 N 8TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2051
Practice Address - Country:US
Practice Address - Phone:920-684-0123
Practice Address - Fax:920-682-7374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental