Provider Demographics
NPI:1811903446
Name:WEIS, ZAK H (DPM)
Entity type:Individual
Prefix:
First Name:ZAK
Middle Name:H
Last Name:WEIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BENTHAVEN PL
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6252
Mailing Address - Country:US
Mailing Address - Phone:806-341-4508
Mailing Address - Fax:
Practice Address - Street 1:10 BENTHAVEN PL
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-6252
Practice Address - Country:US
Practice Address - Phone:806-341-4508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1658213E00000X
CO622213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96704233Medicaid
COP01693987OtherRAILROAD MEDICARE
TX165296803Medicaid
TX8F4469Medicare PIN
CO96704233Medicaid
CO462314Medicare UPIN
CO462317ZSGHMedicare PIN
TX165296803Medicaid