Provider Demographics
NPI:1962509679
Name:ZWICKLBAUER, MICHAEL F (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:ZWICKLBAUER
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 1:895 CITY CENTER BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4250
Mailing Address - Country:US
Mailing Address - Phone:757-873-3500
Mailing Address - Fax:757-591-5240
Practice Address - Street 1:895 CITY CENTER BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4250
Practice Address - Country:US
Practice Address - Phone:757-873-3500
Practice Address - Fax:757-591-5240
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055701208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA240000215Medicaid
6900950Medicare ID - Type Unspecified
VA240000215Medicaid