MEDICARE: DR. RICHARD M ZIRKIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	4301025089	MI

General Provider Information

NPI Number	:	1609032317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD M ZIRKIN M.D.

Provider Business Mailing Address
First Line	:	2089 BORDEAUX ST
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-3012
Country	:	US
Telephone Number	:	248-855-6098
Fax Number	:	248-855-6099

Provider Business Practice Location Address
First Line	:	2089 BORDEAUX ST
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-3012
Country	:	US
Telephone Number	:	248-855-6098
Fax Number	:	248-855-6099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	08/01/2008

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