Healthcare Provider Details

I. General information

NPI: 1891047148
Provider Name (Legal Business Name): CRAIG M ZART PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

2110 LEITER RD
MIAMISBURG OH
45342-3598
US

V. Phone/Fax

Practice location:
  • Phone: 937-395-6010
  • Fax: 937-395-8162
Mailing address:
  • Phone: 937-384-4841
  • Fax: 937-522-7626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003651
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.003651
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: