Healthcare Provider Details

I. General information

NPI: 1003303967
Provider Name (Legal Business Name): ZACHARY HAWKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N SAGINAW ST
LAPEER MI
48446-4600
US

IV. Provider business mailing address

110 N SAGINAW ST
LAPEER MI
48446-4600
US

V. Phone/Fax

Practice location:
  • Phone: 810-535-5587
  • Fax:
Mailing address:
  • Phone: 810-535-5587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: