Healthcare Provider Details

I. General information

NPI: 1003265661
Provider Name (Legal Business Name): COLIN JEFFREY ZAPORSKI P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 W MAPLE RD
WEST BLOOMFIELD TOWSHIP MI
48323
US

IV. Provider business mailing address

26850 PROVIDENCE PKWY STE 260
NOVI MI
48374-1256
US

V. Phone/Fax

Practice location:
  • Phone: 248-854-1064
  • Fax:
Mailing address:
  • Phone: 248-465-5140
  • Fax: 248-465-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007744
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: