Healthcare Provider Details

I. General information

NPI: 1861678856
Provider Name (Legal Business Name): ZAHIRUL TALUKDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 4TH ST SUITE A
JACKSON MI
49203-4518
US

IV. Provider business mailing address

2108 4TH ST SUITE A
JACKSON MI
49203-4518
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-9700
  • Fax: 517-784-8975
Mailing address:
  • Phone: 517-788-9700
  • Fax: 517-784-8975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number5315026665
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: