Provider Demographics
NPI:1881682722
Name:ZIEBELMAN, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:ZIEBELMAN
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 1:222 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-6311
Mailing Address - Country:US
Mailing Address - Phone:863-299-5667
Mailing Address - Fax:863-299-7722
Practice Address - Street 1:222 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-6311
Practice Address - Country:US
Practice Address - Phone:863-299-5667
Practice Address - Fax:863-299-7722
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAZ2801377204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39834900Medicaid
FL59205699533880OtherTRICARE
FL15965OtherBCBS
FL15965UOtherPRUDENTIAL
FL240497OtherAVMED
FL6451249-006OtherCIGNA
FL4632856OtherAETNA
FL216065OtherAMERIGROUP
FL4632856OtherAETNA
FL15965UMedicare ID - Type Unspecified