Individual
KENNETH E ZAWACKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
39475 LEWIS DR STE 110, NOVI, MI 48377
(482) 741-6900
Mailing address
4301 NORTHSTAR WAY, MODESTO, CA 95356-9262
(209) 342-2300
(209) 524-4240
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
20A4278
CA
207Q00000X
Family Medicine Physician
Primary
5101007225
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX42780
—
CA
01
—
020A42780
BLUE SHIELD
CA
Enumeration date
11/04/2005
Last updated
06/21/2018
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