Provider Demographics
NPI:1700102142
Name:ZDRODOWSKI, JAMES (MS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:ZDRODOWSKI
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 S WOOD
Mailing Address - Street 2:M/C 856
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-9531
Mailing Address - Fax:312-355-0739
Practice Address - Street 1:5230 S STATE RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-7936
Practice Address - Country:US
Practice Address - Phone:734-794-0740
Practice Address - Fax:734-881-9426
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL247.000021170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS