Provider Demographics
NPI:1962386342
Name:BASTIAN, ZANE
Entity type:Individual
Prefix:
First Name:ZANE
Middle Name:
Last Name:BASTIAN
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 1:2161 S ROBINSON AVE # B118
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-1377
Mailing Address - Country:US
Mailing Address - Phone:815-742-0727
Mailing Address - Fax:
Practice Address - Street 1:2161 S ROBINSON AVE # B118
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-1377
Practice Address - Country:US
Practice Address - Phone:815-742-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program