Organization
ALLERGY CLINIC OF LIVINGSTON COUNTY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK N ZACKS M.D. (OWNER)
(810) 227-6793
Entity
Organization
Contact information
Practice address
8619 W GRAND RIVER AVE, STE. J, BRIGHTON, MI 48116-2334
(810) 227-6793
(810) 227-5397
Mailing address
8619 W GRAND RIVER AVE, STE. J, BRIGHTON, MI 48116-2334
(810) 227-6793
(810) 227-5397
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
MZ035093
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11217890
AETNA
MI
01
—
2924
GREAT LAKES
MI
05
—
4840320
—
MI
01
—
700D711040
BLUE CARE NETWORK
MI
01
—
93648A
HAP
MI
01
—
M011067
CHAMPUS
MI
Enumeration date
05/16/2007
Last updated
03/25/2009
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