Provider Demographics
NPI:1548605892
Name:FICKO, ZITA (MD)
Entity Type:Individual
Prefix:
First Name:ZITA
Middle Name:
Last Name:FICKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ZITA
Other - Middle Name:
Other - Last Name:FERENCIKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:160 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4560
Mailing Address - Country:US
Mailing Address - Phone:802-775-6006
Mailing Address - Fax:802-773-4946
Practice Address - Street 1:145 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4555
Practice Address - Country:US
Practice Address - Phone:802-775-6006
Practice Address - Fax:802-773-4946
Is Sole Proprietor?:No
Enumeration Date:2013-04-30
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0014049208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1032955Medicaid