Healthcare Provider Details

I. General information

NPI: 1295262129
Provider Name (Legal Business Name): ZHAUNN MIKHAIL SLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 4TH ST
LUBBOCK TX
79430-5302
US

IV. Provider business mailing address

3601 4TH ST
LUBBOCK TX
79430-6211
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-3659
  • Fax: 806-743-3143
Mailing address:
  • Phone: 806-743-6147
  • Fax: 806-743-1599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10060883
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberV0174
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: