Healthcare Provider Details

I. General information

NPI: 1568687135
Provider Name (Legal Business Name): IRENA ZMITROVIC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 NEWBURGH RD
LIVONIA MI
48154-5010
US

IV. Provider business mailing address

14100 NEWBURGH RD
LIVONIA MI
48154-5010
US

V. Phone/Fax

Practice location:
  • Phone: 734-464-7810
  • Fax:
Mailing address:
  • Phone: 734-464-7810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number4301084298
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: