Healthcare Provider Details

I. General information

NPI: 1912312026
Provider Name (Legal Business Name): KATHRYN A ZAVALA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN ANNE DONCHECK

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 03/07/2023
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 MEMORIAL DR
TWO RIVERS WI
54241
US

IV. Provider business mailing address

5300 MEMORIAL DR
TWO RIVERS WI
54241-3923
US

V. Phone/Fax

Practice location:
  • Phone: 920-793-6500
  • Fax:
Mailing address:
  • Phone: 920-793-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number69382
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: