MEDICARE: MARK J ZIADEH MD

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	208100000X	Physical Medicine & Rehabilitation Physician	4301059318	MI
2	204R00000X	Electrodiagnostic Medicine Physician	4301059318	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	:	1649352543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK J ZIADEH MD

Provider Business Mailing Address
First Line	:	PO BOX 1120
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48332-1120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23332 FARMINGTON ROAD
Second Line	:	#1120
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48332
Country	:	US
Telephone Number	:	248-478-5645
Fax Number	:

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	05/26/2017

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