Healthcare Provider Details

I. General information

NPI: 1902049851
Provider Name (Legal Business Name): GEORGE MICHAEL ZACUR M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EAST MEDICAL CENTER DR 8TH FLOOR C.S. MOTT CHILDREN'S HOSPITAL
ANN ARBOR MI
48109-4259
US

IV. Provider business mailing address

3621 SOUTH STATE ST 700 KMS PLACE
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-4185
  • Fax: 734-763-7359
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301103434
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number4301103434
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11484
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: