Healthcare Provider Details

I. General information

NPI: 1730291006
Provider Name (Legal Business Name): WISAM F ZAKKO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 E COMMERCIAL BLVD SUITE 202
FORT LAUDERDALE FL
33308-3763
US

IV. Provider business mailing address

1608 SE 3RD AVE FL 3
FORT LAUDERDALE FL
33316-2564
US

V. Phone/Fax

Practice location:
  • Phone: 954-202-7850
  • Fax: 954-202-7781
Mailing address:
  • Phone: 954-202-7850
  • Fax: 954-202-7781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME71331
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: