Healthcare Provider Details

I. General information

NPI: 1104068386
Provider Name (Legal Business Name): JAMIE LYNN ZUCAL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE LYNN DJORDJEVIC PA

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

IV. Provider business mailing address

16001 W 9 MILE RD # 3
SOUTHFIELD MI
48075-4818
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2698
  • Fax: 313-916-2687
Mailing address:
  • Phone: 248-849-2600
  • Fax: 248-849-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003870
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601003870
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: