Healthcare Provider Details

I. General information

NPI: 1285258574
Provider Name (Legal Business Name): ANDREW B ZOLOT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W LAYTON AVE STE 100
GREENFIELD WI
53220-4136
US

IV. Provider business mailing address

4300 W LAYTON AVE STE 100
GREENFIELD WI
53220-4136
US

V. Phone/Fax

Practice location:
  • Phone: 414-928-2020
  • Fax: 414-210-3402
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD-52802
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberMD-52802
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number85008-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: