Provider Demographics
NPI:1619905387
Name:ZAIDAN, JONATHAN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:THOMAS
Last Name:ZAIDAN
Suffix:
Gender:M
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:PO BOX 2137
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48012-2137
Mailing Address - Country:US
Mailing Address - Phone:248-872-7786
Mailing Address - Fax:248-630-4301
Practice Address - Street 1:1428 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1437
Practice Address - Country:US
Practice Address - Phone:248-693-0543
Practice Address - Fax:248-630-4301
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069018207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1568653780OtherGROUP NPI
MI1619905387Medicaid
MI1619905387Medicaid
MIG56814Medicare UPIN