Healthcare Provider Details

I. General information

NPI: 1790594372
Provider Name (Legal Business Name): DAVID ZACEK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BIOMED BEHAVIOR HEALTH CARE 1044 GILBERT STREET
FLINT MI
48532
US

IV. Provider business mailing address

2233 SCENIC HOLLOW DR
GRAND BLANC MI
48439-2546
US

V. Phone/Fax

Practice location:
  • Phone: 810-422-9406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: