Provider Demographics
NPI:1407884984
Name:ALBALA, MAURIZIO ZEKI (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURIZIO
Middle Name:ZEKI
Last Name:ALBALA
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 1:69 E FOX POINT DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54911-4105
Mailing Address - Country:US
Mailing Address - Phone:920-427-8271
Mailing Address - Fax:920-939-6024
Practice Address - Street 1:526 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-4382
Practice Address - Country:US
Practice Address - Phone:920-939-6015
Practice Address - Fax:920-939-6024
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420567207L00000X, 207LP2900X, 208VP0014X
WI55475-20208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA079691OtherMEDICARE ID-TYPE UNSPECIFIED
PA1011622200001Medicaid
I07165Medicare UPIN