Individual
PERRY EARL ZACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
751 E 81ST AVE, MERRILLVILLE, IN 46410-5538
(219) 791-9476
(219) 791-9542
Mailing address
751 E 81ST AVE, MERRILLVILLE, IN 46410-5538
(219) 791-9476
(219) 791-9542
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02001537
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000093814
BLUE CROSS BLUE SHIELD
IN
05
—
200079230B
—
IN
Enumeration date
03/14/2006
Last updated
01/24/2017
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