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General NPI Number Information
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NPI Number | 1750599569
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Entity Type | Organization
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Legal Business Name | ALLERGY CLINIC OF WARREN PC
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 04/10/2013
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Provider Practice Location Address
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Address Line | 28573 SCHOENHERR RD
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City | WARREN
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State | MI
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Zip | 48088-4330
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Country | US
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Telephone | 586-558-5700
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Fax | 586-558-9402
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Provider Business Mailing Address
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Address Line | 28573 SCHOENHERR RD
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City | WARREN
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State | MI
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Zip | 48088-4330
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Country | US
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Telephone | 586-558-5700
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Fax | 586-558-9402
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK N ZACKS
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Credential | M D
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Telephone | 586-558-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | MZ035093
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License Number State | MI
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