Healthcare Provider Details

I. General information

NPI: 1093710121
Provider Name (Legal Business Name): MICHAEL DAVID ZURENKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 INTERNATIONAL DR
GREENVILLE SC
29615-4816
US

IV. Provider business mailing address

1 INDEPENDENCE PT STE 212
GREENVILLE SC
29615-4536
US

V. Phone/Fax

Practice location:
  • Phone: 864-987-7000
  • Fax: 864-987-7020
Mailing address:
  • Phone: 864-797-6303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number16628
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: