Provider Demographics
NPI:1437507399
Name:ZOLLICKER, SAMUEL MAX (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:MAX
Last Name:ZOLLICKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0998
Mailing Address - Country:US
Mailing Address - Phone:605-782-8305
Mailing Address - Fax:605-336-1677
Practice Address - Street 1:1101 E HOLLY BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-1426
Practice Address - Country:US
Practice Address - Phone:605-582-3853
Practice Address - Fax:605-582-3855
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD11673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine