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NPI Code Detail

MEDICARE: LISA ZACK M.D.

MEDICARE: LISA ZACK M.D.
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
1207N00000XDermatology PhysicianME56408FL
2207ND0101XMOHS-Micrographic Surgery PhysicianME56408FL
3207NI0002XClinical & Laboratory Dermatological Immunology PhysicianME56408FL
4207NP0225XPediatric Dermatology PhysicianME56408FL
5207NS0135XProcedural Dermatology PhysicianME56408FL
6207ND0900XDermatopathology PhysicianME56408FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10387142OTHERFLUNITED HEALTHCARE
208856OTHERFLBCBS
3ZE2985OTHERFLBCBS MA
4713505OTHERFLTUFTS
5568740OTHERFLBCBS PA

General Provider Information

NPI Number : 1467458984
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA ZACK M.D.
Provider Business Mailing Address
First Line : 801 ANCHOR RODE DR
Second Line : STE 100
City : NAPLES
State : FL
Zip : 34103-2742
Country : US
Telephone Number : 239-263-1717
Fax Number : 239-403-9410
Provider Business Practice Location Address
First Line : 801 ANCHOR RODE DR
Second Line : STE 100
City : NAPLES
State : FL
Zip : 34103-2742
Country : US
Telephone Number : 239-263-1717
Fax Number : 239-403-9410
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 09/29/2020

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