MEDICARE: DR. SAJAD ZALZALA M.D.

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	207Q00000X	Family Medicine Physician	C151483	CA
2	207Q00000X	Family Medicine Physician	C1-0012997	DE
3	207Q00000X	Family Medicine Physician	66675	WI
4	207Q00000X	Family Medicine Physician	MD046976	DC
5	207Q00000X	Family Medicine Physician	289619	NY
6	207Q00000X	Family Medicine Physician	35.129936	OH
7	207Q00000X	Family Medicine Physician	77333	GA
8	207Q00000X	Family Medicine Physician	4301094339	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639311509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAJAD ZALZALA M.D.

Provider Business Mailing Address
First Line	:	6437 ARGYLE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48126-2136
Country	:	US
Telephone Number	:	313-653-1790
Fax Number	:	888-655-7536

Provider Business Practice Location Address
First Line	:	835 MASON ST STE A250
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2231
Country	:	US
Telephone Number	:	313-355-8657
Fax Number	:	888-655-7536

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

Provider Enumeration Date	:	03/24/2009
Last Update Date	:	02/04/2022

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