Healthcare Provider Details

I. General information

NPI: 1396725545
Provider Name (Legal Business Name): ANDRZEJ ROBERT ZAJAC D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46591 ROMEO PLANK RD SUITE 200
MACOMB MI
48044-5742
US

IV. Provider business mailing address

43750 GARFIELD RD SUITE 104
CLINTON TWP MI
48038-1135
US

V. Phone/Fax

Practice location:
  • Phone: 586-226-6100
  • Fax: 586-226-6101
Mailing address:
  • Phone: 586-226-6865
  • Fax: 586-226-6880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101012292
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: