Basic Information
| Provider Information | |||||||||
| NPI: | 1013972983 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZINDA | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1104 JOHN NOLEN DR | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537131430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082516868 | ||||||||
| FaxNumber: | 6082514255 | ||||||||
| Practice Location | |||||||||
| Address1: | 1104 JOHN NOLEN DR | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537131430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082516868 | ||||||||
| FaxNumber: | 6082514255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 43903-020 | WI | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 34148700 | 05 | WI | MEDICAID | A29606849 | 01 | WI | DEA | OTHER |