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General NPI Number Information
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NPI Number | 1275621807
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Entity Type | Individual
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Provider Name | MATT ZAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 11/01/2019
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Provider Practice Location Address
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Address Line | 3860 MONROE RD
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City | DE PERE
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State | WI
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Zip | 54115-8399
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Country | US
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Telephone | 920-496-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 E 1ST ST
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City | DULUTH
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State | MN
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Zip | 55805-2407
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Country | US
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Telephone | 218-728-4491
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Fax | 218-728-4404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 50191
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036-113009
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 46164-020
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License Number State | WI
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