Provider Demographics
NPI:1144293275
Name:ZAACKS, PHILIP L (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:L
Last Name:ZAACKS
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 1:506 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2507
Mailing Address - Country:US
Mailing Address - Phone:513-569-5216
Mailing Address - Fax:
Practice Address - Street 1:350 THOMAS MORE PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5465
Practice Address - Country:US
Practice Address - Phone:513-221-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-041292208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC68181Medicare UPIN