Provider Demographics
NPI:1043200256
Name:ZAWAIDEH, MEGAN C (DO)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:C
Last Name:ZAWAIDEH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LISA
Other - Last Name:CLARK DASCENZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1041 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3274
Mailing Address - Country:US
Mailing Address - Phone:248-280-6400
Mailing Address - Fax:248-273-0471
Practice Address - Street 1:1041 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3274
Practice Address - Country:US
Practice Address - Phone:248-280-6400
Practice Address - Fax:248-273-0471
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1740390301OtherPRACTICE NPI
1740390301OtherPRACTICE NPI
I16440Medicare UPIN