Provider Demographics
NPI:1154621910
Name:DOUGLAS J ZAKOLSKI, D.O., P.C.
Entity type:Organization
Organization Name:DOUGLAS J ZAKOLSKI, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZAKOLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-479-4748
Mailing Address - Street 1:16040 KING RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7947
Mailing Address - Country:US
Mailing Address - Phone:734-479-4748
Mailing Address - Fax:734-479-4821
Practice Address - Street 1:16040 KING RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7947
Practice Address - Country:US
Practice Address - Phone:734-479-4748
Practice Address - Fax:734-479-4821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3455354Medicaid
MIOM56660Medicare PIN
MI3455354Medicaid