1619087285 NPI number — MICHAEL ZWANZIGER P.T.

Table of content: MICHAEL ZWANZIGER P.T. (NPI 1619087285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619087285 NPI number — MICHAEL ZWANZIGER P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZWANZIGER
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619087285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 OAKMONT LN STE 600C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTMONT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60559-5548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-575-6250
Provider Business Mailing Address Fax Number:
630-575-7450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3141 S MCCLINTOCK DR STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-566-8125
Provider Business Practice Location Address Fax Number:
480-566-8126
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: 7209 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5550830008 . This is a "MEDICARE NSC SWV" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830001 . This is a "MEDICARE NSC SCW" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830009 . This is a "MEDICARE NSC AZ NORTH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: P00714200 . This is a "RR MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830010 . This is a "MEDICARE NSC GILBERT" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830004 . This is a "MEDICARE NSC PV" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830003 . This is a "MEDICARE NSC PEORIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5550830006 . This is a "MEDICARE NSC ANTHEM" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5550830007 . This is a "MEDICARE NSC DV" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 7209 . This is a "LICENSE #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com