Healthcare Provider Details

I. General information

NPI: 1366096950
Provider Name (Legal Business Name): HAROLD EDWARD ZYLICZ II PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 PICARDY AVE STE 210
BATON ROUGE LA
70809-3749
US

IV. Provider business mailing address

8585 PICARDY AVE STE 210
BATON ROUGE LA
70809-3749
US

V. Phone/Fax

Practice location:
  • Phone: 225-819-1181
  • Fax: 225-246-8333
Mailing address:
  • Phone: 225-819-1181
  • Fax: 225-246-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number320117
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number320117
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: