Provider Demographics
NPI:1801254115
Name:ZELL, SID (MS)
Entity type:Individual
Prefix:MR
First Name:SID
Middle Name:
Last Name:ZELL
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 1:801 N BROADWAY AVE NW
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504
Mailing Address - Country:US
Mailing Address - Phone:885-776-9436
Mailing Address - Fax:
Practice Address - Street 1:801 BROADWAY AVE NW
Practice Address - Street 2:SUITE 203
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4462
Practice Address - Country:US
Practice Address - Phone:855-776-9436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246000217170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS