Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | AZ2801377 | FL |
NPI | 1881682722 |
---|---|
Provider Name | Michael S Ziebelman |
First Address | Winter Haven, FL 33880-6311 |
Second Address | Winter Haven, FL 33880-6311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
15965 | BCBS (01) | FL |
15965U | PRUDENTIAL (01) | FL |
216065 | AMERIGROUP (01) | FL |
240497 | AVMED (01) | FL |
39834900 | (05) | FL |
4632856 | AETNA (01) | FL |
59205699533880 | TRICARE (01) | FL |
6451249-006 | CIGNA (01) | FL |
D21388 | (02) | FL |