Provider Demographics
NPI:1063096170
Name:COMEAU, ZACHARY AUGUSTINE (DO)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:AUGUSTINE
Last Name:COMEAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 W GREEN ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1700
Mailing Address - Country:US
Mailing Address - Phone:269-945-7497
Mailing Address - Fax:269-945-0214
Practice Address - Street 1:1375 W GREEN ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1700
Practice Address - Country:US
Practice Address - Phone:269-945-7497
Practice Address - Fax:269-945-0214
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5101028144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program