Kenneth E Zawacki
Family Doctor Emergency Physician
39475 Lewis Dr Ste 110
Novi
, Michigan 48377
Kenneth E Zawacki
Family Doctor Emergency Physician
39475 Lewis Dr Ste 110
Novi
, Michigan 48377
(209) 524-4240
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About
Features
Specialties
- Emergency Physician
- Family Doctor
Languages spoken
- English
Location
First Address
- Kenneth E Zawacki
- 4301 Northstar Way
- Modesto, CA
- Zip : 95356-9262
- Fax : (209) 524-4240
- Phone : (209) 342-2300
Second Address
- Kenneth E Zawacki
- 39475 Lewis Dr Ste 110
- Novi, MI
- Zip : 48377
- Phone : (482) 741-6900
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207P00000X | Emergency Physician | 20A4278 | CA |
| Y | 207Q00000X | Family Doctor | 5101007225 | MI |
National Provider Identifier
| NPI | 1003807306 |
|---|---|
| Provider Name | Kenneth E Zawacki |
| First Address | Modesto, CA 95356-9262 |
| Second Address | Novi, MI 48377 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 04/11/2005 |
| Last Update Date | 21/06/2018 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 00AX42780 | (05) | CA |
| 020A42780 | BLUE SHIELD (01) | CA |
| E08754 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.