Healthcare Provider Details

I. General information

NPI: 1528447968
Provider Name (Legal Business Name): HAZEM ZEBDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 10/05/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-4800
  • Fax: 517-817-7050
Mailing address:
  • Phone: 313-745-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301117132
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number4301117132
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: