Healthcare Provider Details

I. General information

NPI: 1528058740
Provider Name (Legal Business Name): ZACHARY J ENDRESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 KIRTS BLVD STE 160
TROY MI
48084-4851
US

IV. Provider business mailing address

1350 KIRTS BLVD STE 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:
Title or Position:
Credential:
Phone: