Provider Demographics
NPI:1568944718
Name:RASMUSSEN, ZACHARY ALAN (PA-C)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ALAN
Last Name:RASMUSSEN
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 1:2550 S STATE RD
Mailing Address - Street 2:
Mailing Address - City:CORUNNA
Mailing Address - State:MI
Mailing Address - Zip Code:48817-9308
Mailing Address - Country:US
Mailing Address - Phone:989-413-3217
Mailing Address - Fax:
Practice Address - Street 1:9099 E LANSING RD STE B
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429-1083
Practice Address - Country:US
Practice Address - Phone:989-288-0400
Practice Address - Fax:989-288-7862
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008795363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1568944718Medicaid