Healthcare Provider Details

I. General information

NPI: 1164840930
Provider Name (Legal Business Name): JASON ZATKOFF DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2014
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11012 E 13 MILE RD STE 112A
WARREN MI
48093-2546
US

IV. Provider business mailing address

1507 COLE ST
BIRMINGHAM MI
48009-7063
US

V. Phone/Fax

Practice location:
  • Phone: 586-751-9800
  • Fax:
Mailing address:
  • Phone: 248-252-8768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number5101025124
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number5101025124
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: