Provider Demographics
NPI:1023220159
Name:JIAN ZU, M. D., PLLC
Entity Type:Organization
Organization Name:JIAN ZU, M. D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-569-4500
Mailing Address - Street 1:22250 PROVIDENCE DR. SUITE 403
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075
Mailing Address - Country:US
Mailing Address - Phone:248-569-4500
Mailing Address - Fax:248-569-2126
Practice Address - Street 1:22250 PROVIDENCE DR. SUITE 403
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-569-4500
Practice Address - Fax:248-569-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072649261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH53633Medicare UPIN