Provider Demographics
NPI:1043381353
Name:ZADVINSKIS, PETER ZIGFRID (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ZIGFRID
Last Name:ZADVINSKIS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-486-6790
Mailing Address - Fax:616-486-6702
Practice Address - Street 1:3271 CLEAR VISTA CT NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9477
Practice Address - Country:US
Practice Address - Phone:616-267-7293
Practice Address - Fax:616-267-9594
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIPZ056351207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG11547Medicare UPIN
MIPZ056351OtherLICENSE
MI104493912Medicaid
MI1105434031OtherBLUE CARE NETWORK
MIP00230491OtherRAILROAD MEDICARE
MI364520915OtherPRIORITY HEALTH
MI0P17460001OtherMEDICARE ID #
MI108153OtherPREFERRED CHOICES PPO
MI1105434031OtherBCBS