Healthcare Provider Details

I. General information

NPI: 1538523105
Provider Name (Legal Business Name): ZORMEIER COSMETIC SURGERY & LONGEVITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 EAST STREET STE B
HEALDSBURG CA
95448
US

IV. Provider business mailing address

30158 BLOSSOM LANE
WARREN MI
48088
US

V. Phone/Fax

Practice location:
  • Phone: 317-414-3000
  • Fax: 586-771-9545
Mailing address:
  • Phone: 317-414-3000
  • Fax: 586-945-9545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberA76795
License Number StateCA

VIII. Authorized Official

Name: MS. MICHELE M ZORMEIER
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 317-414-3000