Healthcare Provider Details

I. General information

NPI: 1578723201
Provider Name (Legal Business Name): GWENDOLYN ZIRNGIBL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 W EISENHOWER PKWY STE 208
ANN ARBOR MI
48103-6196
US

IV. Provider business mailing address

13699 E OLD US HIGHWAY 12
CHELSEA MI
48118-9664
US

V. Phone/Fax

Practice location:
  • Phone: 734-475-4500
  • Fax: 734-475-4507
Mailing address:
  • Phone: 734-475-4500
  • Fax: 734-475-4507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301092415
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301092415
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: