Healthcare Provider Details

I. General information

NPI: 1063027977
Provider Name (Legal Business Name): MARY ZHEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MICHIGAN HEART 5303 ELLIOTT DRIVE SECOND FLOOR
YPSILANTI MI
48197-8633
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DRIVE SUITE J2000
ANN ARBOR MI
48105
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-8000
  • Fax: 734-712-8010
Mailing address:
  • Phone: 989-832-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601010116
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: