Provider Demographics
NPI:1548246515
Name:ZACHEIS, H.GALE (MD)
Entity type:Individual
Prefix:MR
First Name:H.GALE
Middle Name:
Last Name:ZACHEIS
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 1:302 W HAY ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4167
Mailing Address - Country:US
Mailing Address - Phone:217-877-7718
Mailing Address - Fax:217-877-4730
Practice Address - Street 1:302 W HAY ST
Practice Address - Street 2:SUITE 205
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4167
Practice Address - Country:US
Practice Address - Phone:217-877-7718
Practice Address - Fax:217-877-4730
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC38810Medicare UPIN
IL284690Medicare ID - Type Unspecified