Healthcare Provider Details

I. General information

NPI: 1881503472
Provider Name (Legal Business Name): ZACKERY ROBERT ACTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 EXPLORER ST
GWINN MI
49841-2813
US

IV. Provider business mailing address

135 E M35
GWINN MI
49841-9160
US

V. Phone/Fax

Practice location:
  • Phone: 906-346-9275
  • Fax:
Mailing address:
  • Phone: 906-346-4924
  • Fax: 906-372-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: