Provider Demographics
NPI:1003074733
Name:ZITZKE, RYAN CORBIN (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:CORBIN
Last Name:ZITZKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:100 N SUMTER ST
Practice Address - Street 2:MEDICAL OFFICE BUILDING 2, SUITE 200
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4975
Practice Address - Country:US
Practice Address - Phone:803-774-7621
Practice Address - Fax:803-774-1791
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36740207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC367409Medicaid
SCSC4441F694Medicare PIN