Healthcare Provider Details

I. General information

NPI: 1346024585
Provider Name (Legal Business Name): ALLISON ZOLTOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21141 MIDDLEBELT RD
FARMINGTON HILLS MI
48336-5516
US

IV. Provider business mailing address

585 MAPLE ST
PLYMOUTH MI
48170-1732
US

V. Phone/Fax

Practice location:
  • Phone: 248-477-7022
  • Fax:
Mailing address:
  • Phone: 734-377-3658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: