Provider Demographics
NPI:1366559254
Name:ZABROWSKI, RANDAL J (MD)
Entity type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:J
Last Name:ZABROWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4541 N EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-7935
Mailing Address - Country:US
Mailing Address - Phone:920-457-0911
Mailing Address - Fax:
Practice Address - Street 1:4541 N EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-7935
Practice Address - Country:US
Practice Address - Phone:920-457-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI283082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30811300Medicaid
WI30811300Medicaid
BZ0869480OtherDEA NUMBER
B57799Medicare UPIN