1821031717 NPI number — DR. GEORGE LEE ZENKER AU.D.

Table of content: DR. GEORGE LEE ZENKER AU.D. (NPI 1821031717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821031717 NPI number — DR. GEORGE LEE ZENKER AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZENKER
Provider First Name:
GEORGE
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
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:
1821031717
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
545 ASHMUN ST
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
SAULT SAINTE MARIE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49783-1936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-259-7150
Provider Business Mailing Address Fax Number:
906-259-1501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
545 ASHMUN ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
SAULT SAINTE MARIE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49783-1936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-259-7150
Provider Business Practice Location Address Fax Number:
906-259-1501
Provider Enumeration Date:
06/14/2006

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: 231H00000X , with the licence number:  1601000481 , 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: 90182103717 . This is a "MEDICAID SUPPLIES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0A70090 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 80182103717 . This is a "MEDICAID SERVICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: MI9314 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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