Healthcare Provider Details

I. General information

NPI: 1952968927
Provider Name (Legal Business Name): ZACHARIAH FIKRU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 FERNWOOD BLVD
FERN PARK FL
32730-2116
US

IV. Provider business mailing address

237 FERNWOOD BLVD
FERN PARK FL
32730-2116
US

V. Phone/Fax

Practice location:
  • Phone: 407-875-3700
  • Fax: 407-659-0411
Mailing address:
  • Phone: 407-875-3700
  • Fax: 407-659-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: