Healthcare Provider Details

I. General information

NPI: 1366480576
Provider Name (Legal Business Name): DAVID GERALD ZICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N PROSPECT ST
BOWLING GREEN OH
43402-1335
US

IV. Provider business mailing address

PO BOX 29
BOWLING GREEN OH
43402-0029
US

V. Phone/Fax

Practice location:
  • Phone: 419-352-5387
  • Fax: 419-352-9605
Mailing address:
  • Phone: 419-352-5387
  • Fax: 419-352-9605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35 052961
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: