Healthcare Provider Details

I. General information

NPI: 1457357865
Provider Name (Legal Business Name): MICHAEL ZACHEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 ANDREA ST
BOWLING GREEN KY
42104-5852
US

IV. Provider business mailing address

201 PARK ST
BOWLING GREEN KY
42101-1708
US

V. Phone/Fax

Practice location:
  • Phone: 270-781-5111
  • Fax: 270-781-0566
Mailing address:
  • Phone: 270-783-3323
  • Fax: 270-781-0566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number24502
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number24502
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: