Healthcare Provider Details

I. General information

NPI: 1154424455
Provider Name (Legal Business Name): MR. GERALD CHARLES ZEMENS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 STODDARD ROAD BOX 41038
MEMPHIS MI
48041
US

IV. Provider business mailing address

401 S MAIN ST PO BOX 678
ALMONT MI
48003-1073
US

V. Phone/Fax

Practice location:
  • Phone: 810-392-2167
  • Fax: 810-392-3530
Mailing address:
  • Phone: 810-441-5396
  • Fax: 810-798-3561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number500044
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: