Healthcare Provider Details

I. General information

NPI: 1083611909
Provider Name (Legal Business Name): MICHAEL J ZICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date: 03/21/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

608 TILGHMAN DR
DUNN NC
28334-5525
US

IV. Provider business mailing address

608 TILGHMAN DR
DUNN NC
28334-5525
US

V. Phone/Fax

Practice location:
  • Phone: 910-892-4092
  • Fax: 910-892-0788
Mailing address:
  • Phone: 910-892-4092
  • Fax: 910-892-0788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number27758
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: