Provider Demographics
NPI:1265448930
Name:ZENZEN, CHARLES T (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:T
Last Name:ZENZEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:30150 TELEGRAPH RD STE 271
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4521
Mailing Address - Country:US
Mailing Address - Phone:248-395-5166
Mailing Address - Fax:734-743-2138
Practice Address - Street 1:2240 E HILL RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-5420
Practice Address - Country:US
Practice Address - Phone:810-579-0202
Practice Address - Fax:810-579-0204
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301074506207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4504284Medicaid
0Z96211Medicare ID - Type Unspecified
MI4504284Medicaid