MEDICARE: ALAN ZELICOFF MD

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	207R00000X	Internal Medicine Physician	81-348	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1043376346	OTHER	NM	GROUP NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124350111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN ZELICOFF MD

Provider Business Mailing Address
First Line	:	4316 CARLISLE BLVD NE
Second Line	:	STE C
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4829
Country	:	US
Telephone Number	:	505-888-1075
Fax Number	:	505-888-1082

Provider Business Practice Location Address
First Line	:	4316 CARLISLE BLVD NE
Second Line	:	STE C
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4829
Country	:	US
Telephone Number	:	505-888-1075
Fax Number	:	505-888-1082

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

Provider Enumeration Date	:	02/02/2010
Last Update Date	:	12/07/2010

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Directions to “ ALAN ZELICOFF MD” Practice Location

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