Healthcare Provider Details

I. General information

NPI: 1417366089
Provider Name (Legal Business Name): LAURA ANN ZDZIARSKI-HORODYSKI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST STE M-206C
KALAMAZOO MI
49007-5359
US

IV. Provider business mailing address

601 JOHN ST STE M-206C
KALAMAZOO MI
49007-5359
US

V. Phone/Fax

Practice location:
  • Phone: 855-618-2676
  • Fax: 269-488-8284
Mailing address:
  • Phone: 855-618-2676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601014078
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-13671
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: