Healthcare Provider Details

I. General information

NPI: 1740549039
Provider Name (Legal Business Name): JAMES L. ZIOBRON DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71441 VAN DYKE RD
BRUCE TWP MI
48065-3808
US

IV. Provider business mailing address

71441 VAN DYKE RD
BRUCE TWP MI
48065-3808
US

V. Phone/Fax

Practice location:
  • Phone: 586-336-3700
  • Fax: 586-336-9443
Mailing address:
  • Phone: 586-336-3700
  • Fax: 586-336-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101012034
License Number StateMI

VIII. Authorized Official

Name: DR. JAMES L ZIOBRON
Title or Position: OWNER
Credential: D.O.
Phone: 586-336-3700