Healthcare Provider Details

I. General information

NPI: 1023096807
Provider Name (Legal Business Name): STEVEN D ZALLA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 W HURON STE 201
WATERFORD TOWNSHIP MI
48328
US

IV. Provider business mailing address

1265 W HURON STE 201
WATERFORD TOWNSHIP MI
48328
US

V. Phone/Fax

Practice location:
  • Phone: 248-683-1212
  • Fax: 248-683-0387
Mailing address:
  • Phone: 248-683-1212
  • Fax: 248-683-0387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101012411
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: