Healthcare Provider Details

I. General information

NPI: 1043224397
Provider Name (Legal Business Name): NATHAN D ZILZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 E FLORENTINE RD STE 206 CARDIOLOGY CLINIC 2ND FLOOR
PRESCOTT VALLEY AZ
86314-2245
US

IV. Provider business mailing address

7700 E FLORENTINE RD STE 206
PRESCOTT VALLEY AZ
86314-2245
US

V. Phone/Fax

Practice location:
  • Phone: 928-442-8117
  • Fax: 928-442-8932
Mailing address:
  • Phone: 928-442-8117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD-16338
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number52031
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: