Healthcare Provider Details

I. General information

NPI: 1730755232
Provider Name (Legal Business Name): ZACHARY ALLAN COFFMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 22ND AVE
MONROE WI
53566-1569
US

IV. Provider business mailing address

2001 GOLF RIDGE TRL
MONROE WI
53566-3105
US

V. Phone/Fax

Practice location:
  • Phone: 608-324-1000
  • Fax:
Mailing address:
  • Phone: 801-889-8394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81440
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125078715
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number81440
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8946
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: