Provider Demographics
NPI:1417382367
Name:JISHI, ZAINAB (PA-C)
Entity Type:Individual
Prefix:
First Name:ZAINAB
Middle Name:
Last Name:JISHI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42680 FORD RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3338
Mailing Address - Country:US
Mailing Address - Phone:734-844-5700
Mailing Address - Fax:734-844-5703
Practice Address - Street 1:42680 FORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3338
Practice Address - Country:US
Practice Address - Phone:734-844-5700
Practice Address - Fax:734-844-5703
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006759363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant