Provider Demographics
NPI:1871581934
Name:ZAZAIAN, JOHN S (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:ZAZAIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3730
Mailing Address - Country:US
Mailing Address - Phone:248-681-1880
Mailing Address - Fax:248-681-3698
Practice Address - Street 1:1012 W HURON ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3730
Practice Address - Country:US
Practice Address - Phone:248-681-1880
Practice Address - Fax:248-681-3698
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI165392311Medicaid
MIOM96610001Medicare ID - Type Unspecified
F05085Medicare UPIN