Provider Demographics
NPI:1750457123
Name:ZVIRBULIS, RAIMONDS A (MD)
Entity Type:Individual
Prefix:
First Name:RAIMONDS
Middle Name:A
Last Name:ZVIRBULIS
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:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:19401 HUBBARD DRIVE
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126
Mailing Address - Country:US
Mailing Address - Phone:313-982-8330
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:19401 HUBBARD DRIVE
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:313-982-8330
Practice Address - Fax:313-982-8294
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030831207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI128735810Medicaid
RZ030831OtherCOMMERCIAL-COMMERCIAL NUMBER
700H262250OtherBLUE CROSS-BLUE CROSS
RZ030831OtherCHAMPUS-CHAMPUS
B49199Medicare UPIN
MI128735810Medicaid