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General NPI Number Information
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NPI Number | 1013167956
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Entity Type | Individual
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Provider Name | GREGORY D ZIKE SR. PA
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Gender | Male
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Dates
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Enumeration Date | 09/29/2008
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 8966 GOULD RD
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City | EDEN PRAIRIE
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State | MN
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Zip | 55347-3326
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Country | US
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Telephone | 605-610-5648
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Fax |
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Provider Business Mailing Address
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Address Line | 8966 GOULD RD.
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City | EDEN PRAIRIE
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State | MN
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Zip | 55347
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Country | US
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Telephone | 605-610-5648
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0134
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1588
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License Number State | IA
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