Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 5101015741 | MI |
Y | 207PE0004X | Emergency Medical Services | 5101015741 | MI |
NPI | 1104039072 |
---|---|
Provider Name | Kevin Zettek |
First Address | Palatine, IL 60055-7767 |
Second Address | Grand Blanc, MI 48439-8065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 06/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5179420 | (05) | MI |
5179448 | (05) | MI |
5179466 | (05) | MI |
KZ015741 | BLUE CROSS BLUE SHIELD (01) | MI |
P00432452 | RAILROAD MEDICARE (01) |