Healthcare Provider Details

I. General information

NPI: 1366885428
Provider Name (Legal Business Name): PHILIP ZUZOLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 3RD ST
SAN FRANCISCO CA
94107-2154
US

IV. Provider business mailing address

10188 FLAGSTONE DR
TWINSBURG OH
44087-4934
US

V. Phone/Fax

Practice location:
  • Phone: 800-929-0926
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number128040
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: