Healthcare Provider Details

I. General information

NPI: 1568944718
Provider Name (Legal Business Name): ZACHARY ALAN RASMUSSEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9099 E LANSING RD STE B
DURAND MI
48429-1083
US

IV. Provider business mailing address

2550 S STATE RD
CORUNNA MI
48817-9308
US

V. Phone/Fax

Practice location:
  • Phone: 989-288-0400
  • Fax: 989-288-7862
Mailing address:
  • Phone: 989-413-3217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601008795
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: