Healthcare Provider Details

I. General information

NPI: 1356802169
Provider Name (Legal Business Name): MARK HAROLD ZELMANSKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21510 HARRINGTON ST STE 102
CLINTON TOWNSHIP MI
48036-2378
US

IV. Provider business mailing address

21510 HARRINGTON ST STE 102
CLINTON TOWNSHIP MI
48036-2378
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-3800
  • Fax:
Mailing address:
  • Phone: 586-228-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101029250
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number5101029250
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: