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General NPI Number Information
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NPI Number | 1366690091
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Entity Type | Individual
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Provider Name | SUSAN MARIE ZIELONKA D.O.
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Gender | Female
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Dates
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Enumeration Date | 09/06/2008
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 6900 E 10 MILE RD
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City | CENTER LINE
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State | MI
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Zip | 48015
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Country | US
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Telephone | 586-756-7777
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Fax | 586-756-7788
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Provider Business Mailing Address
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Address Line | 6800 E 10 MILE RD
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City | CENTER LINE
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State | MI
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Zip | 48015-1167
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Country | US
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Telephone | 586-619-9986
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Fax | 586-806-5085
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101015513
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License Number State | MI
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