Basic Information
| Provider Information | |||||||||
| NPI: | 1467792366 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZITNIK | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | ERIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8891 BUNTON RD | ||||||||
| Address2: | |||||||||
| City: | WILLIS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481919619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6198517202 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 620 JOHN PAUL JONES CIR | ||||||||
| Address2: | NAVAL MEDICAL CENTER PORTSMOUTH | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237082111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579533149 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2013 | ||||||||
| LastUpdateDate: | 03/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | VA | Y | Other Service Providers | Military Health Care Provider |
No ID Information.