Individual
MR. ZACHARY D EBNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPED
Contact information
Practice address
5027 GREEN BAY RD STE 124, KENOSHA, WI 53144-1771
(262) 654-4300
(262) 654-4305
Mailing address
4523 HARDING RD, KENOSHA, WI 53142-3154
(262) 484-7677
(262) 654-4305
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CPED3822
ABC CERTIFICATION
WI
Enumeration date
01/09/2013
Last updated
02/07/2017
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