Provider Demographics
NPI:1578257556
Name:WALEGA, ZACHARY TIMOTHY
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:TIMOTHY
Last Name:WALEGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11815 N WALDRON RD
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:MI
Mailing Address - Zip Code:49249-9679
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11815 N WALDRON RD
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:MI
Practice Address - Zip Code:49249-9679
Practice Address - Country:US
Practice Address - Phone:734-972-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program