Healthcare Provider Details

I. General information

NPI: 1942824453
Provider Name (Legal Business Name): MARC THOMAS ZUGHAIB DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16001 W 9 MILE RD
SOUTHFIELD MI
48075-4818
US

IV. Provider business mailing address

317 NORMANDY RD
ROYAL OAK MI
48073-5111
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-5525
  • Fax:
Mailing address:
  • Phone: 248-953-4909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5151014487
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: