Provider Demographics
NPI:1457357865
Name:ZACHEK, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:ZACHEK
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 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1708
Mailing Address - Country:US
Mailing Address - Phone:270-783-3323
Mailing Address - Fax:270-781-0566
Practice Address - Street 1:1325 ANDREA ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-5852
Practice Address - Country:US
Practice Address - Phone:270-781-5111
Practice Address - Fax:270-781-0566
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24502207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64245020Medicaid
KY64245020Medicaid
KY110029021OtherRAILROAD MEDICARE
KY64245020Medicaid
KY0641101Medicare PIN
KYC78495Medicare UPIN
KY1437401Medicare PIN
KY110029021OtherRAILROAD MEDICARE
KY0535103Medicare PIN