Provider Demographics
NPI:1972886703
Name:RETZLER, ZACHARY BENJAMIN (PA)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:BENJAMIN
Last Name:RETZLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 S WASHINGTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2564
Mailing Address - Country:US
Mailing Address - Phone:989-790-1001
Mailing Address - Fax:989-790-1002
Practice Address - Street 1:912 S WASHINGTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2564
Practice Address - Country:US
Practice Address - Phone:989-790-1001
Practice Address - Fax:989-790-1002
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006179363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical