Provider Demographics
NPI:1366433377
Name:ZICCARDI, MICHAEL A JR (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:ZICCARDI
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:2420 OWEN RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3417
Practice Address - Country:US
Practice Address - Phone:810-496-2500
Practice Address - Fax:810-629-0415
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080172343OtherMETRAHEALTH
MI253396OtherHEALTH ADVANTAGE NETWORK
MI080D410020OtherBLUE CROSS BLUE SHIELD
MI0852502204OtherBLUE CROSS BLUE SHIELD
MI9921034004OtherCIGNA
MIG56808OtherHEALTH NET FEDERAL SERV
MIG56808OtherHEALTH ALLIANCE PLAN
MI080D410020OtherCOMMUNITY BLUE
MI0990939OtherHEALTH PLUS
MI080D410020OtherBLUE CARE NETWORK
MI4361486Medicaid
MI5639565OtherAETNA
MIC7899OtherMCARE
MI080D410020OtherBLUE CROSS POS
MI253396OtherMCLAREN HEALTH PLAN
MI080D410020OtherCOMMUNITY BLUE
MI5639565OtherAETNA
MI080172343OtherMETRAHEALTH