Provider Demographics
NPI:1801881909
Name:ZETOUNA, MELISSA (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ZETOUNA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31313 NORTHWESTERN HWY
Mailing Address - Street 2:STE 203
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2577
Mailing Address - Country:US
Mailing Address - Phone:248-880-0123
Mailing Address - Fax:
Practice Address - Street 1:18 MARKET ST
Practice Address - Street 2:SUITE C
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-7403
Practice Address - Country:US
Practice Address - Phone:586-783-2222
Practice Address - Fax:586-783-6280
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004426363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N84320017Medicare ID - Type Unspecified
Q35149Medicare UPIN