Healthcare Provider Details

I. General information

NPI: 1255394482
Provider Name (Legal Business Name): STEPHEN N ZONCA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 MERCY DR
MUSKEGON MI
49444-1835
US

IV. Provider business mailing address

1316 MERCY DR
MUSKEGON MI
49444-1835
US

V. Phone/Fax

Practice location:
  • Phone: 231-739-9461
  • Fax: 231-733-8131
Mailing address:
  • Phone: 231-739-9461
  • Fax: 231-733-8131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberO65662
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: