1023313525 NPI number — MRS. ERICKA LEANNE ZABICKI MPT

Table of content: MRS. ERICKA LEANNE ZABICKI MPT (NPI 1023313525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023313525 NPI number — MRS. ERICKA LEANNE ZABICKI MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZABICKI
Provider First Name:
ERICKA
Provider Middle Name:
LEANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCARDELL
Provider Other First Name:
ERICKA
Provider Other Middle Name:
LEANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023313525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
47085 GRATIOT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48051-2761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-598-1247
Provider Business Mailing Address Fax Number:
586-598-1260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47085 GRATIOT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48051-2761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-598-1247
Provider Business Practice Location Address Fax Number:
586-598-1260
Provider Enumeration Date:
01/14/2011

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: 225100000X , with the licence number:  5501007528 , 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)





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