Provider Demographics
NPI:1366096950
Name:ZYLICZ, HAROLD EDWARD II (PA)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:EDWARD
Last Name:ZYLICZ
Suffix:II
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 PICARDY AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3749
Mailing Address - Country:US
Mailing Address - Phone:225-819-1181
Mailing Address - Fax:225-246-8333
Practice Address - Street 1:8585 PICARDY AVE STE 210
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3749
Practice Address - Country:US
Practice Address - Phone:225-819-1181
Practice Address - Fax:225-246-8333
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA320117207Y00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology