1831118157 NPI number — DR. MARK ANTHONY ZAINEA MD

Table of content: DR. MARK ANTHONY ZAINEA MD (NPI 1831118157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831118157 NPI number — DR. MARK ANTHONY ZAINEA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZAINEA
Provider First Name:
MARK
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1831118157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50505 SCHOENHERR RD
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
SHELBY TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48315-3140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-580-3062
Provider Business Mailing Address Fax Number:
586-580-3143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50505 SCHOENHERR RD
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
SHELBY TOWNSHIP
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48315-3140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-580-3062
Provider Business Practice Location Address Fax Number:
586-580-3143
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  4301051778 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 4301051778 , 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: 4301051778 . This is a "PHYSICIAN LICENSE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3523365 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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