Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | CH11916 | FL |
N | 111NP0017X | Pediatric Chiropractor | CH11916 | FL |
NPI | 1760936249 |
---|---|
Provider Name | Dr. Maximillan Zdrada |
First Address | Ormond Beach, FL 32174-9534 |
Second Address | Ormond Beach, FL 32174-9534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2016 |
Last Update Date | 12/08/2016 |