Provider Demographics
NPI:1770468050
Name:ZIZELMAN, DANIEL (NP)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ZIZELMAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51483 SEQUOYA DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-4256
Mailing Address - Country:US
Mailing Address - Phone:586-354-3591
Mailing Address - Fax:
Practice Address - Street 1:4466 W BRISTOL RD STE 2A
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3170
Practice Address - Country:US
Practice Address - Phone:810-250-4866
Practice Address - Fax:810-250-4867
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704295984363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily