Provider Demographics
NPI:1104899798
Name:ZANDT, JOHN R (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:ZANDT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:N17 W24100 RIVERWOOD DRIVE SUITE 250
Mailing Address - Street 2:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:WAUKESHA MEMORIAL HOSPITAL-HOSPITALIST PROGRAM
Practice Address - Street 2:725 AMERICAN AVENUE ROOM 2036
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-928-1000
Practice Address - Fax:262-928-6140
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI31971207R00000X
WI31971-020208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31703600Medicaid
WI683750683Medicare PIN
WI31703600Medicaid