Provider Demographics
NPI:1497855571
Name:ZAKELJ, MARY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ZAKELJ
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 1:3900 SUNFOREST CT STE 215
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4440
Mailing Address - Country:US
Mailing Address - Phone:419-473-6670
Mailing Address - Fax:419-473-9959
Practice Address - Street 1:3900 SUNFOREST CT STE 215
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4440
Practice Address - Country:US
Practice Address - Phone:419-473-6670
Practice Address - Fax:419-473-9959
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050647208000000X
OH35.050225208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2734152Medicaid