MEDICARE: ZAK MEDICAL CENTER PC

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	207R00000X	Internal Medicine Physician	34691	AZ

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
2	-1251773-9	OTHER	AZ	CORPORATION NUMBER

General Provider Information

NPI Number	:	1780761809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZAK MEDICAL CENTER PC

Provider Business Mailing Address
First Line	:	PO BOX 10290
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86427-0290
Country	:	US
Telephone Number	:	928-788-1911
Fax Number	:	928-788-1920

Provider Business Practice Location Address
First Line	:	5300 S HIGHWAY 95 STE I
Second Line	:	SUITE I
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9251
Country	:	US
Telephone Number	:	928-788-1911
Fax Number	:	928-788-1920

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PERWAIZ KAHN
Credential	:	M.D.
Telephone Number	:	928-788-1911

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/21/2018

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Directions to “ZAK MEDICAL CENTER PC ” Practice Location

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