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General NPI Number Information
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NPI Number | 1750999660
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Entity Type | Individual
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Provider Name | MICHAEL ZACKERY ZDUNICH PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/16/2020
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 8004 MYRTLE TRACE DR
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City | CONWAY
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State | SC
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Zip | 29526-8945
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Country | US
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Telephone | 843-347-8041
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Fax | 843-347-8042
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Provider Business Mailing Address
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Address Line | 300 SINGLETON RIDGE RD ATTN CREDENTIALING
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City | CONWAY
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State | SC
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Zip | 29526-9142
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Country | US
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Telephone | 843-234-6946
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3654
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License Number State | SC
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