Provider Demographics
NPI:1609305846
Name:ZRULL, MARY NINA (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:NINA
Last Name:ZRULL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:HERMIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:35103 SILVANO ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2685
Mailing Address - Country:US
Mailing Address - Phone:586-791-5250
Mailing Address - Fax:586-791-0408
Practice Address - Street 1:35103 SILVANO ST
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-2685
Practice Address - Country:US
Practice Address - Phone:586-791-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-10
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301113060207Q00000X
MI4301502823207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine