Healthcare Provider Details

I. General information

NPI: 1427436674
Provider Name (Legal Business Name): JUSTINO M ZOMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 W UNIVERSITY DR STE 355
ROCHESTER MI
48307-1871
US

IV. Provider business mailing address

1135 W UNIVERSITY DR STE 355
ROCHESTER MI
48307-1871
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-6030
  • Fax: 248-652-5726
Mailing address:
  • Phone: 248-844-6030
  • Fax: 248-652-5726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301107018
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number4301107018
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: