Provider Demographics
NPI:1114178373
Name:JERRY E ZAYID DPM PC
Entity Type:Organization
Organization Name:JERRY E ZAYID DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZAYID
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:810-724-8030
Mailing Address - Street 1:2559 UNION LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3555
Mailing Address - Country:US
Mailing Address - Phone:810-724-8030
Mailing Address - Fax:810-721-8070
Practice Address - Street 1:1795A S CEDAR ST
Practice Address - Street 2:
Practice Address - City:IMLAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48444-1342
Practice Address - Country:US
Practice Address - Phone:810-724-8030
Practice Address - Fax:586-731-5937
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JERRY E ZAYID DPM PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-07
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001059213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501440OtherBLUE CROSS
MIOEO1735OtherBLUE CROSS
MI0D41146OtherBLUE CROSS
MI103578Medicaid
MI2594961Medicaid
MI2121060Medicaid
MIOH71151OtherBLUE CROSS
MIOP25930Medicare PIN
MIT99007Medicare UPIN
MI103578Medicaid
MIOEO1735OtherBLUE CROSS
MI0821020002Medicare NSC
MIOP60570Medicare PIN