Provider Demographics
NPI:1629419353
Name:SULTANA, ZAKIA (DPM)
Entity Type:Individual
Prefix:
First Name:ZAKIA
Middle Name:
Last Name:SULTANA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20001 W 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3403
Mailing Address - Country:US
Mailing Address - Phone:313-794-5111
Mailing Address - Fax:313-794-5153
Practice Address - Street 1:20001 W 7 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3403
Practice Address - Country:US
Practice Address - Phone:313-794-5111
Practice Address - Fax:313-794-5153
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901400368213E00000X
MD01601213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD479188600Medicaid
MD426040YFCTMedicare PIN
MD479188600Medicaid
MD5068600001Medicare NSC