MEDICARE: MR. PATRICK DALE ZARUCKI MLT

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	246RM2200X	Medical Laboratory Technician

General Provider Information

NPI Number	:	1649460429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK DALE ZARUCKI MLT

Provider Business Mailing Address
First Line	:	2356 KIPLING DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-2331
Country	:	US
Telephone Number	:	781-974-9661
Fax Number	:

Provider Business Practice Location Address
First Line	:	2356 KIPLING DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-2331
Country	:	US
Telephone Number	:	781-974-9661
Fax Number	:

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

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	07/27/2007

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