Provider Demographics
NPI:1255582474
Name:ZIEGENBUSCH, ADAM (DPM)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:ZIEGENBUSCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 LAKEWOOD DR
Mailing Address - Street 2:STE 202
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1883
Mailing Address - Country:US
Mailing Address - Phone:985-385-2616
Mailing Address - Fax:985-385-2618
Practice Address - Street 1:1302 LAKEWOOD DR STE 202
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1883
Practice Address - Country:US
Practice Address - Phone:985-385-2616
Practice Address - Fax:985-385-2618
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005358213ES0103X
LA200028213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00805525OtherMEDICARE RAIL ROAD
LA1801585Medicaid
LA4M266DU99Medicare PIN