Healthcare Provider Details

I. General information

NPI: 1285823575
Provider Name (Legal Business Name): ZENAIDA MIRELA HOMENTCOVSCHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ZENAIDA MIRELA DIACONU M.D.

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 01/06/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E MOUNT HOPE AVE WELL CHILD CLINIC
LANSING MI
48910-3207
US

IV. Provider business mailing address

901 E MOUNT HOPE AVE WELL CHILD CLINIC
LANSING MI
48910-3207
US

V. Phone/Fax

Practice location:
  • Phone: 517-372-9175
  • Fax: 517-372-9188
Mailing address:
  • Phone: 517-372-9175
  • Fax: 517-372-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301085884
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: