MEDICARE: DONALD P ZIETZ AAS-HIS

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	237700000X	Hearing Instrument Specialist	HA00004650	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093089591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD P ZIETZ AAS-HIS

Provider Business Mailing Address
First Line	:	22525 SE 64TH PL
Second Line	:	STE 2030
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-5383
Country	:	US
Telephone Number	:	425-358-0956
Fax Number	:	877-481-6931

Provider Business Practice Location Address
First Line	:	1810 E COLLEGE WAY
Second Line	:	SUITE 110
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-2362
Country	:	US
Telephone Number	:	360-336-5881
Fax Number	:	360-336-2323

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

Provider Enumeration Date	:	03/01/2012
Last Update Date	:	08/12/2014

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