Provider Demographics
NPI:1700075892
Name:ZONA, MICHAEL A (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:ZONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:NIWOT
Mailing Address - State:CO
Mailing Address - Zip Code:80544-0819
Mailing Address - Country:US
Mailing Address - Phone:310-261-0035
Mailing Address - Fax:888-908-4542
Practice Address - Street 1:6654 GUNPARK DRIVE
Practice Address - Street 2:#101
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:310-261-0035
Practice Address - Fax:888-908-4542
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG668752084P0800X
CO493652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE47647Medicare UPIN
CAWG66875BMedicare PIN