Healthcare Provider Details

I. General information

NPI: 1568797579
Provider Name (Legal Business Name): MALLORI ANN DZURKA R.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MALLORI ANN LAHAR R.D

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W. CEDAR
STANDISH MI
48658
US

IV. Provider business mailing address

805 W. CEDAR
STANDISH MI
48658
US

V. Phone/Fax

Practice location:
  • Phone: 989-846-3407
  • Fax:
Mailing address:
  • Phone: 989-846-3407
  • Fax: 989-846-3544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: