Individual
DR. MARK G ZUKAITIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2825 RANDOLPH RD, CHARLOTTE, NC 28211-1075
(704) 377-1647
(704) 358-8267
Mailing address
PO BOX 5615, FRESNO, CA 93755-5615
(559) 436-1000
(559) 354-4235
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
20225
NC
207LP2900X
Pain Medicine (Anesthesiology) Physician
20225
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1146V
BLUE CROSS NC ID#
NC
05
—
891146V
—
NC
05
—
N20225
—
SC
Enumeration date
04/14/2006
Last updated
08/31/2016
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