Healthcare Provider Details

I. General information

NPI: 1588752265
Provider Name (Legal Business Name): HERMAN ZICHERMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3268 YOSEMITE DR
LAKE ORION MI
48360-1034
US

IV. Provider business mailing address

1500 WEISS ST
SAGINAW MI
48602-5251
US

V. Phone/Fax

Practice location:
  • Phone: 248-763-0111
  • Fax:
Mailing address:
  • Phone: 989-293-1978
  • Fax: 313-341-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000972
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: