Provider Demographics
NPI:1407811243
Name:LUCIA ZAMORANO MD PLC
Entity Type:Organization
Organization Name:LUCIA ZAMORANO MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING AGENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZAMORANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-723-2477
Mailing Address - Street 1:2004 HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6807
Mailing Address - Country:US
Mailing Address - Phone:248-723-2477
Mailing Address - Fax:248-681-3209
Practice Address - Street 1:5107 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-3426
Practice Address - Country:US
Practice Address - Phone:248-723-2477
Practice Address - Fax:248-681-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407640208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104779750Medicaid
MIE92639Medicare UPIN
MI6031710001Medicare NSC
MI0P21690Medicare PIN