Provider Demographics
NPI:1083611909
Name:ZICH, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:ZICH
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 1:608 TILGHMAN DR
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-5525
Mailing Address - Country:US
Mailing Address - Phone:910-892-4092
Mailing Address - Fax:910-892-0788
Practice Address - Street 1:608 TILGHMAN DR
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5525
Practice Address - Country:US
Practice Address - Phone:910-892-4092
Practice Address - Fax:910-892-0788
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-03-11
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
NC27758174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0146COtherBLUE CROSS BLUE SHIELD NC
NC8989920Medicaid
NC0146COtherBLUE CROSS BLUE SHIELD NC
NCC44149Medicare UPIN