Healthcare Provider Details

I. General information

NPI: 1750396412
Provider Name (Legal Business Name): PATRICK MICHAEL ZIETZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2144 E PARIS AVE SE STE 240
GRAND RAPIDS MI
49546-6117
US

IV. Provider business mailing address

2144 E PARIS AVE SE STE 240
GRAND RAPIDS MI
49546-6117
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-8945
  • Fax: 616-949-1115
Mailing address:
  • Phone: 616-949-8945
  • Fax: 616-949-1115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME95457
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301078370
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: