Provider Demographics
NPI:1790303758
Name:SARAFINY, ZANE MICHAEL
Entity Type:Individual
Prefix:
First Name:ZANE
Middle Name:MICHAEL
Last Name:SARAFINY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:CASPIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49915-0153
Mailing Address - Country:US
Mailing Address - Phone:906-284-3333
Mailing Address - Fax:
Practice Address - Street 1:121 W 4TH ST
Practice Address - Street 2:
Practice Address - City:CASPIAN
Practice Address - State:MI
Practice Address - Zip Code:49915-5103
Practice Address - Country:US
Practice Address - Phone:906-284-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5601011355363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program