Healthcare Provider Details

I. General information

NPI: 1306007943
Provider Name (Legal Business Name): ANDREW JAMES ZILLGITT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 INKSTER RD
GARDEN CITY MI
48135-4001
US

IV. Provider business mailing address

13391 PINEVIEW WAY APT 206
SOUTHGATE MI
48195-3469
US

V. Phone/Fax

Practice location:
  • Phone: 734-458-4486
  • Fax:
Mailing address:
  • Phone: 517-420-6958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number5101017270
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: