Provider Demographics
NPI:1740397363
Name:MACINSKI, ZACHARY P (MD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:P
Last Name:MACINSKI
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 1:2129 SW MILLERS GLEN DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-5017
Mailing Address - Country:US
Mailing Address - Phone:860-830-4110
Mailing Address - Fax:
Practice Address - Street 1:2200 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622-0001
Practice Address - Country:US
Practice Address - Phone:785-350-4452
Practice Address - Fax:785-350-4304
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0215762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001215763Medicaid
B39347Medicare UPIN
CT130000127Medicare ID - Type Unspecified