Provider Demographics
NPI:1285112037
Name:HABERMAAS, ZACHARY STEVEN
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:STEVEN
Last Name:HABERMAAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 BROOKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-9084
Mailing Address - Country:US
Mailing Address - Phone:217-853-6994
Mailing Address - Fax:
Practice Address - Street 1:1266 BROOKFIELD DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-9084
Practice Address - Country:US
Practice Address - Phone:217-853-6994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program