Active NPI
Kenneth E Zawacki, DO
- Family Medicine Physician
- Novi, MI
National Provider Identifier
1003807306
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 5101007225
- Practice address
- 39475 Lewis Dr Ste 110
Novi, MI 48377 - Phone
- (482) 741-6900
- NPI assigned
- Nov 4, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 20A4278 | CA | |
| Family Medicine Physician | 207Q00000X | 5101007225 | MI | Primary |
Addresses
Primary practice location
39475 Lewis Dr Ste 110
Novi, MI 48377
Mailing address
4301 Northstar Way
Modesto, CA 95356-9262
Phone (209) 342-2300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00AX42780 | Medicaid | CA | |
| 020A42780 | Other | CA | BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101007225 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529539200000",
"number": "1003807306",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4301 NORTHSTAR WAY",
"city": "MODESTO",
"state": "CA",
"postal_code": "953569262",
"telephone_number": "209-342-2300",
"fax_number": "209-524-4240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "39475 LEWIS DR STE 110",
"city": "NOVI",
"state": "MI",
"postal_code": "48377",
"telephone_number": "482-741-6900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZAWACKI",
"first_name": "KENNETH",
"middle_name": "E",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-04",
"last_updated": "2018-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "CA",
"license": "20A4278",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "5101007225",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00AX42780",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "020A42780",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Novi, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.