Provider Demographics
NPI:1417164575
Name:ZAK, DANIAL JEROME (DO)
Entity Type:Individual
Prefix:
First Name:DANIAL
Middle Name:JEROME
Last Name:ZAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3681 OKEMOS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-6923
Mailing Address - Country:US
Mailing Address - Phone:517-273-4944
Mailing Address - Fax:517-441-4730
Practice Address - Street 1:3681 OKEMOS RD STE 500
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-6923
Practice Address - Country:US
Practice Address - Phone:517-410-8546
Practice Address - Fax:517-441-4730
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010157352084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry