Healthcare Provider Details

I. General information

NPI: 1003146069
Provider Name (Legal Business Name): ZACHARY J ENDRESS JR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 KIRTS BLVD SUITE 160
TROY MI
48084-4851
US

IV. Provider business mailing address

1350 KIRTS BLVD SUITE 160
TROY MI
48084-4851
US

V. Phone/Fax

Practice location:
  • Phone: 248-244-9426
  • Fax: 248-244-9495
Mailing address:
  • Phone: 248-244-9426
  • Fax: 248-244-9495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301029545
License Number StateMI

VIII. Authorized Official

Name: DR. ZACHARY J ENDRESS
Title or Position: PRESIDENT
Credential: MD
Phone: 248-244-9426