Healthcare Provider Details

I. General information

NPI: 1386227957
Provider Name (Legal Business Name): SARAH BETH ZIKO BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH BETH BUTCHER

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/03/2021
Certification Date: 05/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7209 ENGLE RD STE 200
FORT WAYNE IN
46804-2238
US

IV. Provider business mailing address

10100 ELIDA RD
DELPHOS OH
45833-9056
US

V. Phone/Fax

Practice location:
  • Phone: 260-484-4600
  • Fax:
Mailing address:
  • Phone: 419-695-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: