Healthcare Provider Details

I. General information

NPI: 1679555643
Provider Name (Legal Business Name): NAHED A ZAKARIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 KIRTS BLVD STE 400
TROY MI
48084-4881
US

IV. Provider business mailing address

1080 KIRTS BLVD STE 400
TROY MI
48084-4881
US

V. Phone/Fax

Practice location:
  • Phone: 248-362-2660
  • Fax: 248-362-0662
Mailing address:
  • Phone: 248-362-2660
  • Fax: 248-362-0662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301045682
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: