Provider Demographics
NPI:1407901267
Name:ZIOBRON, JAMES L (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:ZIOBRON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:71441 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:BRUCE
Mailing Address - State:MI
Mailing Address - Zip Code:48065-3808
Mailing Address - Country:US
Mailing Address - Phone:586-336-3700
Mailing Address - Fax:586-336-9443
Practice Address - Street 1:71441 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:BRUCE
Practice Address - State:MI
Practice Address - Zip Code:48065-3808
Practice Address - Country:US
Practice Address - Phone:586-336-3700
Practice Address - Fax:586-336-9443
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF94898Medicare UPIN
MI0M08910Medicare ID - Type Unspecified