Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MT210435 | PA |
Y | 2080P0202X | Pediatric Cardiologist | 4301117287 | MI |
NPI | 1154770931 |
---|---|
Provider Name | Dominic Zanaboni |
First Address | Ann Arbor, MI 48109-4000 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2016 |
Last Update Date | 10/07/2019 |