Provider Demographics
NPI:1770545931
Name:ZOLLO, KENNETH A (MD)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:A
Last Name:ZOLLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1675 N FREEDOM BLVD
Mailing Address - Street 2:BLDG 3
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2540
Mailing Address - Country:US
Mailing Address - Phone:801-377-8000
Mailing Address - Fax:801-377-8001
Practice Address - Street 1:1675 N FREEDOM BLVD
Practice Address - Street 2:BLDG 3
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2540
Practice Address - Country:US
Practice Address - Phone:801-377-8000
Practice Address - Fax:801-377-8001
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT3227931205208000000X
UT3227938905208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics