Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | LZ002070 | MI |
NPI | 1174581607 |
---|---|
Provider Name | Lorne Alec Zielaskowski |
First Address | Alpena, MI 49707-1375 |
Second Address | Alpena, MI 49707-1375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 08/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4728723 | (05) | MI |
LZ002070 | MICHIGAN LICENSE NUMBER (01) | MI |
U73610 | (02) |