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NPI Code Detail

MEDICARE: LISA D ZACK MD PA

MEDICARE: LISA D ZACK MD PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician

General Provider Information

NPI Number : 1518189927
Entity Type Code : Organization
Provider Name (Legal Business Name) : LISA D ZACK MD PA
Provider Business Mailing Address
First Line : 801 ANCHOR RODE DRIVE
Second Line : SUITE 100
City : NAPLES
State : FL
Zip : 34103-2742
Country : US
Telephone Number : 239-263-1717
Fax Number : 239-403-9410
Provider Business Practice Location Address
First Line : 801 ANCHOR RODE DRIVE
Second Line : SUITE 100
City : NAPLES
State : FL
Zip : 34103-2742
Country : US
Telephone Number : 239-263-1717
Fax Number : 239-403-9410
Authorized Official
Title or Position : BILLING
Name : MS. TRACY ANN SMITH
Credential :
Telephone Number : 239-263-1717
Provider Enumeration Date : 05/03/2007
Last Update Date : 12/29/2011

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