Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 0110840802 | VA |
NPI | 1013988781 |
---|---|
Provider Name | Michael J Zugarek |
First Address | Va Beach, VA 23452 |
Second Address | Va Beach, VA 23452 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 13/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
970006832 | MEDICARE RAILROAD (01) | VA |
S62046 | (02) |