Provider Demographics
NPI:1689640831
Name:ZMIEJKO, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:ZMIEJKO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3050 COMMERCE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3819
Mailing Address - Country:US
Mailing Address - Phone:810-385-4441
Mailing Address - Fax:810-385-1540
Practice Address - Street 1:4154 RIVER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:EAST CHINA
Practice Address - State:MI
Practice Address - Zip Code:48054-2925
Practice Address - Country:US
Practice Address - Phone:810-329-6710
Practice Address - Fax:810-329-8790
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2011-04-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301042415208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689640831Medicaid
MI1689640831Medicaid