Provider Demographics
NPI:1750496154
Name:HAMMOUD, ZANE TAYSIR (MD)
Entity Type:Individual
Prefix:
First Name:ZANE
Middle Name:TAYSIR
Last Name:HAMMOUD
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 1:16001 W 9 MILE RD # 3
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4818
Mailing Address - Country:US
Mailing Address - Phone:248-384-9260
Mailing Address - Fax:248-849-2610
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:CARDIOTHORACIC SURGERY K-14
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-2698
Practice Address - Fax:313-916-2687
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091678208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200309410Medicaid
IN074790RMedicare ID - Type Unspecified
IN200309410Medicaid