Provider Demographics
NPI:1417392549
Name:MULLETT, ANNETTE ZIELKE (MD)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:ZIELKE
Last Name:MULLETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18393 CLAIRMONT CIR E
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8535
Mailing Address - Country:US
Mailing Address - Phone:248-449-3101
Mailing Address - Fax:
Practice Address - Street 1:18393 CLAIRMONT CIR E
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-8535
Practice Address - Country:US
Practice Address - Phone:248-449-3101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068897208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice