Healthcare Provider Details

I. General information

NPI: 1952341703
Provider Name (Legal Business Name): FOLKERT G. ZIJLSTRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 W JEFFERSON BLVD SUITE 201
FORT WAYNE IN
46804-4128
US

IV. Provider business mailing address

6920 POINTE INVERNESS WAY STE 200
FORT WAYNE IN
46804-7934
US

V. Phone/Fax

Practice location:
  • Phone: 260-432-2297
  • Fax: 260-969-7266
Mailing address:
  • Phone: 260-479-3514
  • Fax: 260-479-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01039411A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: