Provider Demographics
NPI:1174837405
Name:HEATHER ZACUR, PC
Entity Type:Organization
Organization Name:HEATHER ZACUR, PC
Other - Org Name:ZACUR PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZACUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-479-7246
Mailing Address - Street 1:PO BOX 674361
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19725 ALLEN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1090
Practice Address - Country:US
Practice Address - Phone:734-479-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301097317207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty