Individual
PHILLIP ZALOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
W190N5053 SUNSET VIEW DR, MENOMONEE FALLS, WI 53051-6436
(262) 783-6265
Mailing address
W190N5053 SUNSET VIEW DR, MENOMONEE FALLS, WI 53051-6436
(262) 783-6265
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
815-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42960800
—
WI
Enumeration date
09/15/2005
Last updated
07/08/2007
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