Provider Demographics
NPI:1780047894
Name:ZALIS, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ZALIS
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 1:1250 MELISSA LN
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-3047
Mailing Address - Country:US
Mailing Address - Phone:954-242-0365
Mailing Address - Fax:
Practice Address - Street 1:500 N HIATUS RD STE 200
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5213
Practice Address - Country:US
Practice Address - Phone:954-437-4800
Practice Address - Fax:954-437-6628
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1567052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology