Provider Demographics
NPI:1790729366
Name:ZACK, RONALD GENE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GENE
Last Name:ZACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20276 MIDDLEBELT RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2054
Mailing Address - Country:US
Mailing Address - Phone:248-476-4900
Mailing Address - Fax:248-476-5435
Practice Address - Street 1:20276 MIDDLEBELT RD
Practice Address - Street 2:SUITE 2
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2054
Practice Address - Country:US
Practice Address - Phone:248-476-4900
Practice Address - Fax:248-476-5435
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIRZ033941207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI445049710Medicaid
MI444671610Medicaid
MI445049710Medicaid
MIF37177001Medicare ID - Type UnspecifiedINDIVIDUAL