Healthcare Provider Details

I. General information

NPI: 1770670564
Provider Name (Legal Business Name): LAUREN B ZOSCHNICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39901 TRADITIONS DR SUITE 240
NORTHVILLE MI
48168-9493
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 248-305-4400
  • Fax:
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301050019
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: