MEDICARE: KEVIN A ZACOUR D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS005098L	PA
2	207Q00000X	Family Medicine Physician	34.003531	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	024351	OTHER	PA	MEDICARE ID
4	4112483	OTHER	OH	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245206853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN A ZACOUR D.O.

Provider Business Mailing Address
First Line	:	267 CENTER ST
Second Line	:
City	:	SEVILLE
State	:	OH
Zip	:	44273-8864
Country	:	US
Telephone Number	:	330-769-2941
Fax Number	:	330-769-4804

Provider Business Practice Location Address
First Line	:	267 CENTER ST
Second Line	:
City	:	SEVILLE
State	:	OH
Zip	:	44273-8864
Country	:	US
Telephone Number	:	330-769-2941
Fax Number	:	330-769-4804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	11/15/2011

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Directions to “ KEVIN A ZACOUR D.O.” Practice Location

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