Provider Demographics
NPI:1568847341
Name:ZICKUS TRANSITIONS MHT LLC
Entity Type:Organization
Organization Name:ZICKUS TRANSITIONS MHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ZICKUS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-443-9734
Mailing Address - Street 1:2285 S MICHIGAN RD
Mailing Address - Street 2:P O BOX 266
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-9206
Mailing Address - Country:US
Mailing Address - Phone:844-633-4663
Mailing Address - Fax:
Practice Address - Street 1:2285 S MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:EATON RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:48827-9206
Practice Address - Country:US
Practice Address - Phone:844-633-4663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty