Healthcare Provider Details

I. General information

NPI: 1013664150
Provider Name (Legal Business Name): CAITLYN ZEITZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 HOBART ST
CADILLAC MI
49601-2379
US

IV. Provider business mailing address

1425 E 24 RD
CADILLAC MI
49601-8305
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-2644
  • Fax:
Mailing address:
  • Phone: 231-878-0969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601011046
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: