Provider Demographics
NPI:1720669880
Name:ENDOMETRIOSIS TREATMENT CENTER OF AMERICA - MICHIGAN PLLC
Entity Type:Organization
Organization Name:ENDOMETRIOSIS TREATMENT CENTER OF AMERICA - MICHIGAN PLLC
Other - Org Name:ENDOMETRIOSIS TREATMENT CENTER OF AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-693-1630
Mailing Address - Street 1:1430 S LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1437
Mailing Address - Country:US
Mailing Address - Phone:248-693-1630
Mailing Address - Fax:248-731-2156
Practice Address - Street 1:1430 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1437
Practice Address - Country:US
Practice Address - Phone:248-693-1630
Practice Address - Fax:248-731-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty