Provider Demographics
NPI:1144683517
Name:ZILISCH, JOSEPH EDWARD
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EDWARD
Last Name:ZILISCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:434-295-1000
Mailing Address - Fax:434-972-4266
Practice Address - Street 1:5150 N PORT WASHINGTON RD STE 251
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-5477
Practice Address - Country:US
Practice Address - Phone:414-332-0606
Practice Address - Fax:414-967-3604
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101269431207W00000X
WI75083207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1144683517Medicaid