Provider Demographics
NPI:1306997127
Name:ZALLAKIAN, ANNE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:ANNE MARIE
Middle Name:
Last Name:ZALLAKIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 690
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-0690
Mailing Address - Country:US
Mailing Address - Phone:734-692-6775
Mailing Address - Fax:
Practice Address - Street 1:8572 PAULINA AVE
Practice Address - Street 2:
Practice Address - City:GROSSE ILE
Practice Address - State:MI
Practice Address - Zip Code:48138-1051
Practice Address - Country:US
Practice Address - Phone:734-692-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407469208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2857042Medicaid
MI0203500252OtherBLUE CROSSBLUE SHIELD
MIM023122OtherCHAMPUS
MI0203500252OtherBLUE CROSSBLUE SHIELD
MIM023122OtherCHAMPUS