Provider Demographics
NPI:1740549039
Name:JAMES L. ZIOBRON DO PC
Entity type:Organization
Organization Name:JAMES L. ZIOBRON DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZIOBRON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-336-3700
Mailing Address - Street 1:71441 VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:BRUCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48065-3808
Mailing Address - Country:US
Mailing Address - Phone:586-336-3700
Mailing Address - Fax:586-336-9443
Practice Address - Street 1:71441 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:BRUCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48065-3808
Practice Address - Country:US
Practice Address - Phone:586-336-3700
Practice Address - Fax:586-336-9443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM108910Medicare PIN