Provider Demographics
NPI:1942256714
Name:VAN ZYL, HEINRO (MD)
Entity Type:Individual
Prefix:
First Name:HEINRO
Middle Name:
Last Name:VAN ZYL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 CROASDAILE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2508
Mailing Address - Country:US
Mailing Address - Phone:919-425-1565
Mailing Address - Fax:919-425-0778
Practice Address - Street 1:3000 CORAL HILLS DR
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4108
Practice Address - Country:US
Practice Address - Phone:954-344-3108
Practice Address - Fax:919-425-0478
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39056207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009910989Medicaid
TN4151568OtherBLUE CROSS
TN3327767Medicaid
TN4097072OtherBLUE CROSS
TNP00294890OtherMEDICARE RAILROAD
TN3327768Medicaid
TN4106417OtherBLUE CROSS
TNP00294890OtherMEDICARE RAILROAD
TN4106417OtherBLUE CROSS
TN3327767Medicaid
TN3327767Medicare PIN