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General NPI Number Information
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NPI Number | 1881889491
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Entity Type | Organization
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Legal Business Name | PERRY E ZACK DO
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 1400 S LAKE PARK AVE SUIT 405
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City | HOBART
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State | IN
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Zip | 46342-6636
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Country | US
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Telephone | 219-945-0090
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Fax | 219-945-1118
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Provider Business Mailing Address
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Address Line | 1400 S LAKE PARK AVE SUIT 405
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City | HOBART
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State | IN
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Zip | 46342-6636
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Country | US
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Telephone | 219-945-0090
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Fax | 219-945-1118
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Authorized Official
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Title or Position | OWNER
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Name | MR. PERRY EARL ZACK
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Credential | D.O.
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Telephone | 219-945-0090
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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 | 02001537
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License Number State | IN
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