Healthcare Provider Details

I. General information

NPI: 1063204485
Provider Name (Legal Business Name): ZACHARY FLEURY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 SUTLER AVE
BELOIT WI
53511-6918
US

IV. Provider business mailing address

2030 SUTLER AVE
BELOIT WI
53511-6918
US

V. Phone/Fax

Practice location:
  • Phone: 608-362-8889
  • Fax:
Mailing address:
  • Phone: 608-362-8889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2139-60
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: