MEDICARE: MICHAEL FRANCIS ZODA PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MT1221	FL

General Provider Information

NPI Number	:	1063475739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL FRANCIS ZODA PHD

Provider Business Mailing Address
First Line	:	1535 KILLEARN CENTER BLVD
Second Line	:	SUITE C2
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-3467
Country	:	US
Telephone Number	:	850-668-2959
Fax Number	:	850-894-9957

Provider Business Practice Location Address
First Line	:	1535 KILLEARN CENTER BLVD
Second Line	:	SUITE C2
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-3467
Country	:	US
Telephone Number	:	850-668-2959
Fax Number	:	850-894-9957

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/08/2007

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