Provider Demographics
NPI:1639472749
Name:MICHAEL I ZUFLACHT,MD,PA
Entity Type:Organization
Organization Name:MICHAEL I ZUFLACHT,MD,PA
Other - Org Name:DOING BUSINESS AS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:V
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-614-3335
Mailing Address - Street 1:2829 BABCOCK RD
Mailing Address - Street 2:SUITE 429
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6028
Mailing Address - Country:US
Mailing Address - Phone:210-615-8888
Mailing Address - Fax:210-615-8892
Practice Address - Street 1:2829 BABCOCK RD
Practice Address - Street 2:SUITE 429
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6028
Practice Address - Country:US
Practice Address - Phone:210-615-8888
Practice Address - Fax:210-615-8892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD7379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102105703Medicaid
TX0076WCOtherBCBSTX
TXTXB120792Medicare PIN