Healthcare Provider Details

I. General information

NPI: 1841434222
Provider Name (Legal Business Name): LAURA ZELENAK, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6672 NEWARK RD
IMLAY CITY MI
48444-9657
US

IV. Provider business mailing address

6672 NEWARK RD
IMLAY CITY MI
48444-9657
US

V. Phone/Fax

Practice location:
  • Phone: 810-724-0591
  • Fax: 810-724-0272
Mailing address:
  • Phone: 810-724-0591
  • Fax: 810-724-0272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101014679
License Number StateMI

VIII. Authorized Official

Name: LAURA ERMAN ZELENAK
Title or Position: OWNER
Credential: D.O.
Phone: 810-724-0591