Provider Demographics
NPI:1467626226
Name:WALTER J. ZETUSKY, PH.D., P.C.
Entity Type:Organization
Organization Name:WALTER J. ZETUSKY, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZETUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PC
Authorized Official - Phone:734-425-0700
Mailing Address - Street 1:33135 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1625
Mailing Address - Country:US
Mailing Address - Phone:734-425-0700
Mailing Address - Fax:734-425-9666
Practice Address - Street 1:33135 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1625
Practice Address - Country:US
Practice Address - Phone:734-425-0700
Practice Address - Fax:734-425-9666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006416103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P23530Medicare PIN