Healthcare Provider Details

I. General information

NPI: 1942468616
Provider Name (Legal Business Name): A Z DERMATOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25225 GREENFIELD
SOUTHFIELD MI
48075
US

IV. Provider business mailing address

31051 WESTWOOD ROAD IN CARE OF A ZELIKOV MD
FARMINGTON HILLS MI
48331
US

V. Phone/Fax

Practice location:
  • Phone: 248-788-4380
  • Fax:
Mailing address:
  • Phone: 248-788-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301046052
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number4301046052
License Number StateMI

VIII. Authorized Official

Name: DR. ANATOLY ZELIKOV
Title or Position: OWNER
Credential: MD
Phone: 248-788-4380