Healthcare Provider Details

I. General information

NPI: 1831796267
Provider Name (Legal Business Name): JOWHARH ZINDANI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOWHARA ZINDANI PA-C

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12020 MITCHELL ST
HAMTRAMCK MI
48212-2722
US

IV. Provider business mailing address

12020 MITCHELL ST
HAMTRAMCK MI
48212-2722
US

V. Phone/Fax

Practice location:
  • Phone: 248-828-6323
  • Fax:
Mailing address:
  • Phone: 248-828-6323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: