Provider Demographics
NPI:1952524522
Name:ZICHICHI PODIATRY CLINIC
Entity Type:Organization
Organization Name:ZICHICHI PODIATRY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ZICHICHI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:504-888-9403
Mailing Address - Street 1:3901 HOUMA BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2930
Mailing Address - Country:US
Mailing Address - Phone:504-888-9403
Mailing Address - Fax:504-888-2895
Practice Address - Street 1:3901 HOUMA BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2930
Practice Address - Country:US
Practice Address - Phone:504-888-9403
Practice Address - Fax:504-888-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD066R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4013637OtherAETNA US HEALTHCARE
LA4337291950OtherBLUE CROSS BLUE SHIELD
LAT20083Medicare UPIN
LA5C249Medicare ID - Type UnspecifiedGROUP ID # FOR MEDICARE