MEDICARE: MICHAEL H ZAKEM D.O.

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	207RH0003X	Hematology & Oncology Physician	5101007887	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	830001753	OTHER	MI	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0F71000	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1316948771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL H ZAKEM D.O.

Provider Business Mailing Address
First Line	:	5800 FOREMOST DR SE STE 300
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-7062
Country	:	US
Telephone Number	:	616-389-1725
Fax Number	:	616-954-1724

Provider Business Practice Location Address
First Line	:	5800 FOREMOST DR SE STE 200
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-7062
Country	:	US
Telephone Number	:	616-389-1800
Fax Number	:	616-389-1839

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	12/02/2022

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