Healthcare Provider Details

I. General information

NPI: 1174837405
Provider Name (Legal Business Name): HEATHER ZACUR, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19725 ALLEN RD SUITE 102
BROWNSTOWN TWP MI
48183-1090
US

IV. Provider business mailing address

PO BOX 674361
DETROIT MI
48267-0001
US

V. Phone/Fax

Practice location:
  • Phone: 734-479-7246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4301097317
License Number StateMI

VIII. Authorized Official

Name: HEATHER A. ZACUR
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: MD
Phone: 734-479-7246