Provider Demographics
NPI:1619995529
Name:ZENI, TALLAL M (MD)
Entity Type:Individual
Prefix:DR
First Name:TALLAL
Middle Name:M
Last Name:ZENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14555 LEVAN
Mailing Address - Street 2:STE. 311
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1971
Mailing Address - Country:US
Mailing Address - Phone:734-655-2692
Mailing Address - Fax:734-655-4218
Practice Address - Street 1:14555 LEVAN
Practice Address - Street 2:STE. 311
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1971
Practice Address - Country:US
Practice Address - Phone:734-655-2692
Practice Address - Fax:734-655-4218
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301085677208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4738022Medicaid
MII31304Medicare UPIN
MI0N12200126Medicare ID - Type Unspecified