Provider Demographics
NPI:1619929312
Name:ZURACK, ROBERT A (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:ZURACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19020 FORT ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-6701
Mailing Address - Country:US
Mailing Address - Phone:734-362-5100
Mailing Address - Fax:734-362-5147
Practice Address - Street 1:19020 FORT ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-6701
Practice Address - Country:US
Practice Address - Phone:734-362-5100
Practice Address - Fax:734-362-5147
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005583208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H21076OtherBCBSM
MI3221640Medicaid
MI118560OtherMERCY CARE CHOICES
MIDR820514OtherMCARE
MICC3713OtherRR MEDICARE
MI5101005583OtherPHYSICIAN LICNESE
MI4035225OtherAETNA
MI6462946OtherCIGNA
MI455677OtherUHC
MICC3713OtherRR MEDICARE
MICC3713OtherRR MEDICARE
MI5101005583OtherPHYSICIAN LICNESE