Healthcare Provider Details

I. General information

NPI: 1619283579
Provider Name (Legal Business Name): ELIZABETH G ZWICK P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2010
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 N WEST AVE
JACKSON MI
49201-1903
US

IV. Provider business mailing address

214 N WEST AVE
JACKSON MI
49201-1903
US

V. Phone/Fax

Practice location:
  • Phone: 517-784-9189
  • Fax:
Mailing address:
  • Phone: 517-784-9189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601005728
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: