Provider Demographics
NPI:1790314052
Name:ZILLS, ZACHARY JOHN
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JOHN
Last Name:ZILLS
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:W64N625 HANOVER AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-3404
Mailing Address - Country:US
Mailing Address - Phone:920-904-1566
Mailing Address - Fax:
Practice Address - Street 1:W64N625 HANOVER AVE APT 101
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-3404
Practice Address - Country:US
Practice Address - Phone:920-904-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program