Healthcare Provider Details

I. General information

NPI: 1306997127
Provider Name (Legal Business Name): ANNE MARIE ZALLAKIAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8572 PAULINA AVE
GROSSE ILE MI
48138-1051
US

IV. Provider business mailing address

PO BOX 690
GROSSE ILE MI
48138-0690
US

V. Phone/Fax

Practice location:
  • Phone: 734-692-6775
  • Fax:
Mailing address:
  • Phone: 734-692-6775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301407469
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: