Provider Demographics
NPI:1366416463
Name:PODGORICA, ZAMIR GANI (MD)
Entity type:Individual
Prefix:
First Name:ZAMIR
Middle Name:GANI
Last Name:PODGORICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1682
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-1682
Mailing Address - Country:US
Mailing Address - Phone:616-774-5221
Mailing Address - Fax:616-774-5391
Practice Address - Street 1:1840 WEALTHY ST SE
Practice Address - Street 2:MC 426
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-2921
Practice Address - Country:US
Practice Address - Phone:616-774-5221
Practice Address - Fax:616-774-5391
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301068204207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4617027Medicaid
P00051953OtherRAILROAD MEDICARE
MI4532556Medicaid
MI4532565Medicaid
MI110D111790OtherBCBSM
MI4617027Medicaid