1447347406 NPI number — JERRY E ZAYID DPM PC

Table of content: (NPI 1447347406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447347406 NPI number — JERRY E ZAYID DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JERRY E ZAYID DPM PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447347406
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2559 UNION LAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMMERCE TWP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48382-3555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-245-3392
Provider Business Mailing Address Fax Number:
248-363-8652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2559 UNION LAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMMERCE TWP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48382-3555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-245-3392
Provider Business Practice Location Address Fax Number:
248-363-8652
Provider Enumeration Date:
10/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZAYID
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-245-3392

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  5901001059 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0D41146 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 103578 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2594961 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: O-EO-2656-O . This is a "BLUE CROSS SUPPLIER PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OH71150 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5501440 . This is a "BLUECROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2121060 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: OEO2782 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OEO3185 . This is a "BLUE CROSS" identifier , issued by the state of ( MH ) . This identifiers is of the category "OTHER".




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