Active NPI
Anne Marie Zallakian, M.D.
- Surgery Physician
- Grosse Ile, MI
National Provider Identifier
1306997127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 4301407469
- Practice address
- 8572 Paulina Ave
Grosse Ile, MI 48138-1051 - Phone
- (734) 692-6775
- NPI assigned
- Jan 16, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 4301407469 | MI | Primary |
Addresses
Primary practice location
8572 Paulina Ave
Grosse Ile, MI 48138-1051
Mailing address
PO Box 690
Grosse Ile, MI 48138-0690
Phone (734) 692-6775
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2857042 | Medicaid | MI | |
| 0203500252 | Other | MI | BLUE CROSSBLUE SHIELD |
| M023122 | Other | MI | CHAMPUS |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301407469 | MI | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1306997127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 690",
"city": "GROSSE ILE",
"state": "MI",
"postal_code": "481380690",
"telephone_number": "734-692-6775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8572 PAULINA AVE",
"city": "GROSSE ILE",
"state": "MI",
"postal_code": "481381051",
"telephone_number": "734-692-6775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZALLAKIAN",
"first_name": "ANNE MARIE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MI",
"license": "4301407469",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2857042",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSSBLUE SHIELD",
"identifier": "0203500252",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "M023122",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grosse Ile, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.