Provider Demographics
NPI:1093749012
Name:ADVANCED LIFE CARE MEDICAL GROUP
Entity Type:Organization
Organization Name:ADVANCED LIFE CARE MEDICAL GROUP
Other - Org Name:MICHAEL A. ZONA, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-261-0035
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:NIWOT
Mailing Address - State:CO
Mailing Address - Zip Code:80544-0819
Mailing Address - Country:US
Mailing Address - Phone:310-261-0035
Mailing Address - Fax:949-208-6981
Practice Address - Street 1:2255 S 88TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9716
Practice Address - Country:US
Practice Address - Phone:303-673-9990
Practice Address - Fax:949-208-6981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG668752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ48692ZOtherBLUE SHIELD
CACN3641OtherRR MEDICARE
CAZZZ48692ZOtherBLUE SHIELD
CAW11234AMedicare PIN