Provider Demographics
NPI:1447208343
Name:ZANGMEISTER, JOHN MARK (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MARK
Last Name:ZANGMEISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:MARK
Other - Last Name:ZANGMEISTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:FAMILY MEDICINE CENTER
Mailing Address - Street 2:11709 LORAIN AVE.
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5443
Mailing Address - Country:US
Mailing Address - Phone:216-671-5006
Mailing Address - Fax:216-671-5004
Practice Address - Street 1:11709 LORAIN AVE
Practice Address - Street 2:FAMILY MEDICINE CENTER
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111
Practice Address - Country:US
Practice Address - Phone:216-671-5006
Practice Address - Fax:216-671-5004
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050158Z207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA16832Medicare UPIN
7368341Medicare PIN