Healthcare Provider Details

I. General information

NPI: 1750599569
Provider Name (Legal Business Name): ALLERGY CLINIC OF WARREN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28573 SCHOENHERR RD
WARREN MI
48088-4330
US

IV. Provider business mailing address

28573 SCHOENHERR RD
WARREN MI
48088-4330
US

V. Phone/Fax

Practice location:
  • Phone: 586-558-5700
  • Fax: 586-558-9402
Mailing address:
  • Phone: 586-558-5700
  • Fax: 586-558-9402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMZ035093
License Number StateMI

VIII. Authorized Official

Name: DR. MARK N ZACKS
Title or Position: OWNER
Credential: M D
Phone: 586-558-5700