Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | D0069504 | MD |
NPI | 1003953290 |
---|---|
Provider Name | Dr. Michelle Zikusoka |
First Address | Baltimore, MD 21239-2945 |
Second Address | Baltimore, MD 21239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 15/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
024652200 | (05) | MD |