MEDICARE: ZAKLINA DENDOOVEN CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	4704217495	MI

General Provider Information

NPI Number	:	1003873076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZAKLINA DENDOOVEN CRNA

Provider Business Mailing Address
First Line	:	1 FORD PL STE 3A
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48202-3450
Country	:	US
Telephone Number	:	800-999-5829
Fax Number	:	313-876-1305

Provider Business Practice Location Address
First Line	:	6071 W OUTER DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-2624
Country	:	US
Telephone Number	:	952-442-9770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	03/24/2026

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