Provider Demographics
NPI:1205070711
Name:ZAGATA, MATEUSZ JAKUB (MD)
Entity type:Individual
Prefix:
First Name:MATEUSZ
Middle Name:JAKUB
Last Name:ZAGATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:855-253-4836
Practice Address - Street 1:1211 JACARANDA BLVD UNIT 2
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-4520
Practice Address - Country:US
Practice Address - Phone:941-483-3377
Practice Address - Fax:941-483-4687
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54825207Q00000X
FLME 122877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16405800Medicaid
FLHBTWQOtherBCBS FL
FLM8052OtherFL MEDICARE