Healthcare Provider Details

I. General information

NPI: 1700189917
Provider Name (Legal Business Name): ZACHARY WEBER CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2010
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 KEYSTONE DR STE F
MAUMEE OH
43537-8796
US

IV. Provider business mailing address

3652 DEER CREEK DR
MAUMEE OH
43537-7902
US

V. Phone/Fax

Practice location:
  • Phone: 419-401-5010
  • Fax:
Mailing address:
  • Phone: 865-297-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number175
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: