Provider Demographics
NPI:1982620639
Name:ZADALIS, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:ZADALIS
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 1:6829 N 72ND ST STE 5500
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1729
Mailing Address - Country:US
Mailing Address - Phone:402-572-3663
Mailing Address - Fax:402-572-3438
Practice Address - Street 1:6829 N 72ND ST STE 5500
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122
Practice Address - Country:US
Practice Address - Phone:402-572-3663
Practice Address - Fax:402-572-3438
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE20318208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025085100Medicaid
G73387Medicare UPIN
NE10025085100Medicaid