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General NPI Number Information
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NPI Number | 1619905387
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Entity Type | Individual
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Provider Name | JONATHAN THOMAS ZAIDAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 1428 S LAPEER RD
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City | LAKE ORION
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State | MI
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Zip | 48360-1437
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Country | US
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Telephone | 248-693-0543
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Fax | 248-630-4301
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Provider Business Mailing Address
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Address Line | PO BOX 2137
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City | BIRMINGHAM
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State | MI
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Zip | 48012-2137
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Country | US
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Telephone | 248-872-7786
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Fax | 248-630-4301
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301069018
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License Number State | MI
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