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General NPI Number Information
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NPI Number | 1821033226
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Entity Type | Organization
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Legal Business Name | RAYMOND ZASTROW MD SC
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 6735 W BRADLEY RD
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City | MILWAUKEE
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State | WI
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Zip | 53223
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Country | US
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Telephone | 414-354-3300
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Fax | 262-784-5472
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Provider Business Mailing Address
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Address Line | 11701 N RIVER RIDGE DR
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City | MEQUON
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State | WI
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Zip | 53092-2755
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Country | US
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Telephone | 414-354-3300
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Fax | 262-784-5472
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAYMOND ZASTROW
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Credential | MD
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Telephone | 414-354-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 28127
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License Number State | WI
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