Provider Demographics
NPI:1710636279
Name:ZENK, MADISON CLAIRE
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:CLAIRE
Last Name:ZENK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:CLAIRE
Other - Last Name:ZENK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5881 W 16TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2910
Mailing Address - Country:US
Mailing Address - Phone:970-652-2235
Mailing Address - Fax:970-652-2827
Practice Address - Street 1:5881 W 16TH ST STE B
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2910
Practice Address - Country:US
Practice Address - Phone:970-652-2235
Practice Address - Fax:970-652-2827
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0074842208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program