Healthcare Provider Details

I. General information

NPI: 1053524421
Provider Name (Legal Business Name): JOSEPH SCOTT ZICKAFOOSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W MICHIGAN AVE
YPSILANTI MI
48197-5443
US

IV. Provider business mailing address

1500 E MEDICAL CENTER DR
ANN ARBOR MI
48109-5000
US

V. Phone/Fax

Practice location:
  • Phone: 734-539-5080
  • Fax:
Mailing address:
  • Phone: 734-647-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57009054
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301095310
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35089753
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD53314
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: