Healthcare Provider Details

I. General information

NPI: 1548334170
Provider Name (Legal Business Name): STEPHANIE A ZESKIND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20321 FARMINGTON RD
LIVONIA MI
48152-1411
US

IV. Provider business mailing address

3621 S STATE ST 700 KMS PLACE
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 248-888-9000
  • Fax:
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301081892
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: