Provider Demographics
NPI:1447287651
Name:ZEPPA, MICHAEL ANDREW (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANDREW
Last Name:ZEPPA
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 1:101 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0556
Mailing Address - Country:US
Mailing Address - Phone:209-571-6622
Mailing Address - Fax:209-527-2069
Practice Address - Street 1:1524 MCHENRY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4500
Practice Address - Country:US
Practice Address - Phone:209-577-4444
Practice Address - Fax:209-527-2069
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG767132085B0100X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G767130Medicaid
CA00G767132Medicare PIN
CA00G767138Medicare PIN
CA00G7671310Medicare PIN
CA00G7671313Medicare PIN
CA00G767135Medicare PIN
CA00G7671312Medicare PIN
CA00G767139Medicare PIN
CA00G767131Medicare PIN
CA00G7671311Medicare PIN
CA00G767133Medicare PIN
CA00G767134Medicare PIN
CA300073549Medicare PIN
CA00G767130Medicare PIN
CA00G767130Medicaid
CA00G767137Medicare PIN
CA00G7671314Medicare PIN
CA00G7671315Medicare PIN
CA00G767136Medicare PIN