Healthcare Provider Details

I. General information

NPI: 1821481292
Provider Name (Legal Business Name): ZACHARY KYLE WEST DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 N WASHINGTON ST
TIFFIN OH
44883-1522
US

IV. Provider business mailing address

3040 N TOWNSHIP ROAD 155
TIFFIN OH
44883-9508
US

V. Phone/Fax

Practice location:
  • Phone: 567-804-5777
  • Fax:
Mailing address:
  • Phone: 419-618-5338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number34.012669CTR
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.012669CTR
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: