Provider Demographics
NPI:1689600496
Name:ZIRILLE, MICHAEL J (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:ZIRILLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 TOWNSHIP ROAD 1525
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669
Mailing Address - Country:US
Mailing Address - Phone:740-441-0504
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:292 TOWNSHIP ROAD 1525
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669
Practice Address - Country:US
Practice Address - Phone:740-441-0504
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2019-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-4148207Q00000X
WV1269207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000006675OtherANTHEM BCBS
OH000000185205OtherUNISON MEDICAID
C30674OtherRR MEDICARE
OH310917085128OtherCARESOURCE MEDICAID
OH0706427OtherMOLINA MEDICAID
001714060OtherMOUNTAIN STATE BCBS
OH310917085128OtherCARESOURCE MEDICAID
001714060OtherMOUNTAIN STATE BCBS
C30674OtherRR MEDICARE
OH0611435Medicare PIN