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General NPI Number Information
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NPI Number | 1386921104
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Entity Type | Organization
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Legal Business Name | THEODOR V.B. VON ZIELINSKI, M.D., P.A.
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Dates
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Enumeration Date | 11/08/2011
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 777 37TH ST C104
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City | VERO BEACH
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State | FL
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Zip | 32960-4873
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Country | US
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Telephone | 772-562-8773
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Fax | 772-562-0646
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Provider Business Mailing Address
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Address Line | 777 37TH ST C104
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City | VERO BEACH
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State | FL
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Zip | 32960-4873
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Country | US
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Telephone | 772-562-8773
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Fax | 772-562-0646
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Authorized Official
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Title or Position | OWNER
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Name | DR. THEODOR V.B. VON ZIELINSKI
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Credential | M.D.
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Telephone | 772-562-8773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME37467
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License Number State | FL
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