Basic Information
| Provider Information | |||||||||
| NPI: | 1255582474 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIEGENBUSCH | ||||||||
| FirstName: | ADAM | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1302 LAKEWOOD DR | ||||||||
| Address2: | STE 202 | ||||||||
| City: | MORGAN CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703801883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9853852616 | ||||||||
| FaxNumber: | 9853852618 | ||||||||
| Practice Location | |||||||||
| Address1: | 1302 LAKEWOOD DR STE 202 | ||||||||
| Address2: | |||||||||
| City: | MORGAN CITY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703801883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9853852616 | ||||||||
| FaxNumber: | 9853852618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2008 | ||||||||
| LastUpdateDate: | 03/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 016005358 | IL | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0103X | 200028 | LA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00805525 | 01 | LA | MEDICARE RAIL ROAD | OTHER | 1801585 | 05 | LA | MEDICAID |