Provider Demographics
NPI:1821031717
Name:ZENKER, GEORGE LEE (AUD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LEE
Last Name:ZENKER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 ASHMUN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1936
Mailing Address - Country:US
Mailing Address - Phone:906-259-7150
Mailing Address - Fax:906-259-1501
Practice Address - Street 1:545 ASHMUN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1936
Practice Address - Country:US
Practice Address - Phone:906-259-7150
Practice Address - Fax:906-259-1501
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000481231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI90182103717OtherMEDICAID SUPPLIES
MI0A70090OtherBCBS
MI80182103717OtherMEDICAID SERVICES
MIMI9314OtherMEDICARE PTAN
MIMI9314Medicare UPIN