Provider Demographics
NPI:1649447707
Name:ZETTELL, LORIANN (MD)
Entity type:Individual
Prefix:
First Name:LORIANN
Middle Name:
Last Name:ZETTELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13697 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-8533
Mailing Address - Country:US
Mailing Address - Phone:269-789-4905
Mailing Address - Fax:269-789-7955
Practice Address - Street 1:13697 15 MILE RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-8533
Practice Address - Country:US
Practice Address - Phone:269-789-4905
Practice Address - Fax:269-789-7955
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056520207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700A376690OtherBCBSM
MI700A376690OtherBCBSM
MI0A37669031Medicare PIN