Individual
MAVERICK CHARLES ZIETLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
21772 S ELLSWORTH LOOP RD, QUEEN CREEK, AZ 85142-7709
(480) 512-3700
Mailing address
21772 S ELLSWORTH LOOP RD, QUEEN CREEK, AZ 85142-7709
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
07/23/2024
Last updated
07/23/2024
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