Healthcare Provider Details

I. General information

NPI: 1366416463
Provider Name (Legal Business Name): ZAMIR GANI PODGORICA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 WEALTHY ST SE MC 426
GRAND RAPIDS MI
49506-2921
US

IV. Provider business mailing address

PO BOX 1682
GRAND RAPIDS MI
49501-1682
US

V. Phone/Fax

Practice location:
  • Phone: 616-774-5221
  • Fax: 616-774-5391
Mailing address:
  • Phone: 616-774-5221
  • Fax: 616-774-5391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301068204
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301068204
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: