Provider Demographics
NPI:1093708844
Name:ZELDES, STEVEN S (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:S
Last Name:ZELDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 W MAPLE RD
Mailing Address - Street 2:#200
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4406
Mailing Address - Country:US
Mailing Address - Phone:248-737-6955
Mailing Address - Fax:248-737-8759
Practice Address - Street 1:6010 W MAPLE RD
Practice Address - Street 2:#200
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4406
Practice Address - Country:US
Practice Address - Phone:248-737-6955
Practice Address - Fax:248-737-8759
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2022-07-29
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
MI4301067910207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4512670Medicaid
MIH15168Medicare UPIN
MI4512670Medicaid