Iczkovitz, Michael L

Iczkovitz, Michael L is an individual health care provider with primary practice located at 3303 Trier Rd , Fort Wayne IN 46815-4768. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Iczkovitz, Michael L can be contacted via phone (260) 484-9990.

Contact Information

Primary practice address
3303 Trier Rd Fort Wayne IN 46815-4768
Phone: (260) 484-9990
Fax: (260) 484-6573
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 12008664 Indiana
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 2901011066 Michigan

Profile Details

NPI number 1235159930
LBN Legal business name Iczkovitz, Michael L
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2006
Last updated Mar 26th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1235159930 NPPES
Indiana MEDICAID 100079980
Indiana Other 000000086698

Popular Providers