Provider Demographics
NPI:1841247160
Name:ZACCAGNINI, ANN VERONICA (DO)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:VERONICA
Last Name:ZACCAGNINI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W BIG BEAVER
Mailing Address - Street 2:STE 150
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-649-2323
Mailing Address - Fax:248-649-5998
Practice Address - Street 1:42450 HAYES
Practice Address - Street 2:STE 100
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-412-2225
Practice Address - Fax:586-412-2226
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIAZ013438208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114707278Medicaid
H43279Medicare UPIN
N93670005Medicare ID - Type Unspecified