Provider Demographics
NPI:1538609672
Name:ZYLSTRA, DAVID MARK II
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MARK
Last Name:ZYLSTRA
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 GARFIELD AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-7191
Mailing Address - Country:US
Mailing Address - Phone:989-475-1068
Mailing Address - Fax:
Practice Address - Street 1:202 GARFIELD AVE
Practice Address - Street 2:APT 3
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7191
Practice Address - Country:US
Practice Address - Phone:989-475-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor