Provider Demographics
NPI:1639311509
Name:ZALZALA, SAJAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SAJAD
Middle Name:
Last Name:ZALZALA
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 1:6437 ARGYLE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2136
Mailing Address - Country:US
Mailing Address - Phone:313-653-1790
Mailing Address - Fax:888-655-7536
Practice Address - Street 1:835 MASON ST STE A250
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2231
Practice Address - Country:US
Practice Address - Phone:313-355-8657
Practice Address - Fax:888-655-7536
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC151483207Q00000X
DEC1-0012997207Q00000X
WI66675207Q00000X
DCMD046976207Q00000X
NY289619207Q00000X
OH35.129936207Q00000X
GA77333207Q00000X
MI4301094339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine