Healthcare Provider Details

I. General information

NPI: 1861530438
Provider Name (Legal Business Name): TERRI A ZOMERLEI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 S HAGADORN RD STE 600
EAST LANSING MI
48823-5383
US

IV. Provider business mailing address

4070 LAKE DRIVE SE SUITE 202
GRAND RAPIDS MI
49546
US

V. Phone/Fax

Practice location:
  • Phone: 517-267-2460
  • Fax: 517-884-8602
Mailing address:
  • Phone: 616-464-4420
  • Fax: 616-464-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number57
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number4301117082
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: