Provider Demographics
NPI:1780761809
Name:ZAK MEDICAL CENTER PC
Entity type:Organization
Organization Name:ZAK MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERWAIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-788-1911
Mailing Address - Street 1:PO BOX 10290
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86427-0290
Mailing Address - Country:US
Mailing Address - Phone:928-788-1911
Mailing Address - Fax:928-788-1920
Practice Address - Street 1:5300 S HIGHWAY 95 STE I
Practice Address - Street 2:SUITE I
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9251
Practice Address - Country:US
Practice Address - Phone:928-788-1911
Practice Address - Fax:928-788-1920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34691207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ999295Medicaid
AZ-1251773-9OtherCORPORATION NUMBER
AZ-1251773-9OtherCORPORATION NUMBER