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General NPI Number Information
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NPI Number | 1831089630
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Entity Type | Individual
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Provider Name | LADAN KHOMAMI ZADEH MD
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Gender | Female
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Dates
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Enumeration Date | 07/04/2025
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Last Update Date | 07/04/2025
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Provider Practice Location Address
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Address Line | 1 GENESYS PKWY RM 2620
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City | GRAND BLANC
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State | MI
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Zip | 48439-8065
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Country | US
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Telephone | 810-606-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 3413 FOLEY GLEN DR
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City | FENTON
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State | MI
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Zip | 48430-3440
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Country | US
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Telephone | 778-999-9000
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4351054464
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License Number State | MI
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