MEDICARE: JAMES M ZASULY MD

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	208200000X	Plastic Surgery Physician	43535	WI

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

General Provider Information

NPI Number	:	1932120573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES M ZASULY MD

Provider Business Mailing Address
First Line	:	2845 GREENBRIER RD STE 230
Second Line	:	PO BOX 8900
City	:	GREEN BAY
State	:	WI
Zip	:	54308-8900
Country	:	US
Telephone Number	:	920-288-8240
Fax Number	:	920-288-8255

Provider Business Practice Location Address
First Line	:	2605 DEVELOPMENT DR
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-4240
Country	:	US
Telephone Number	:	920-288-8240
Fax Number	:	920-857-1488

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	01/24/2018

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