Provider Demographics
NPI:1902910854
Name:ZGODA, MICHAEL SR (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ZGODA
Suffix:SR
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:PO BOX 33269
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85067-3269
Mailing Address - Country:US
Mailing Address - Phone:602-406-4786
Mailing Address - Fax:916-636-4358
Practice Address - Street 1:500 W THOMAS RD STE 900A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4223
Practice Address - Country:US
Practice Address - Phone:602-406-3540
Practice Address - Fax:602-406-7186
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ61607207RP1001X, 207RP1001X
NC20061104207RP1001X
NC2006-01104207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902910854Medicaid
SCN01109Medicaid
NC143RKOtherBCBS
NC5904535Medicaid
NCNCA686AMedicare PIN
NC2063133BMedicare PIN
KYH43501Medicare UPIN
NCP00417397Medicare PIN
NC5904535Medicaid
NC2063133AMedicare PIN