Provider Demographics
NPI:1447347406
Name:JERRY E ZAYID DPM PC
Entity type:Organization
Organization Name:JERRY E ZAYID DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZAYID
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-245-3392
Mailing Address - Street 1:2559 UNION LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3555
Mailing Address - Country:US
Mailing Address - Phone:248-245-3392
Mailing Address - Fax:248-363-8652
Practice Address - Street 1:2559 UNION LAKE RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-3555
Practice Address - Country:US
Practice Address - Phone:248-245-3392
Practice Address - Fax:248-363-8652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2015-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001059213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D41146OtherBLUE CROSS
MI103578Medicaid
MI2594961Medicaid
MIO-EO-2656-OOtherBLUE CROSS SUPPLIER PIN
MIOH71150OtherBLUE CROSS
MI5501440OtherBLUECROSS
MI2121060Medicaid
MIOEO2782OtherBLUE CROSS
MHOEO3185OtherBLUE CROSS
MI0821020002Medicare NSC
MI0D41146OtherBLUE CROSS
MIOP60570Medicare PIN
MI2121060Medicaid
MI480018918Medicare PIN