Provider Demographics
NPI:1417470469
Name:TOMASOSKI, ZACHARY (PA-C)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:TOMASOSKI
Suffix:
Gender:M
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 1:6020 W PIERSON RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2335
Mailing Address - Country:US
Mailing Address - Phone:810-407-7989
Mailing Address - Fax:
Practice Address - Street 1:1485 E M 21
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9048
Practice Address - Country:US
Practice Address - Phone:989-494-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315226798363AM0700X
ORPA185145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant