Provider Demographics
NPI:1124260088
Name:ZARBOCK, BRIAN KARL (CSA)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KARL
Last Name:ZARBOCK
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SOUTH DEWEY ST.
Mailing Address - Street 2:
Mailing Address - City:SOMONAUK
Mailing Address - State:IL
Mailing Address - Zip Code:60552
Mailing Address - Country:US
Mailing Address - Phone:815-593-0817
Mailing Address - Fax:
Practice Address - Street 1:320 SOUTH DEWEY ST.
Practice Address - Street 2:
Practice Address - City:SOMONAUK
Practice Address - State:IL
Practice Address - Zip Code:60552
Practice Address - Country:US
Practice Address - Phone:815-593-0817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL113725246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist