Basic Information
Provider Information
NPI: 1811915721
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZARNOSKY
FirstName: AARON
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5900 BYRON CENTER AVE SW
Address2: MEDICAL ADMINISTRATION
City: WYOMING
State: MI
PostalCode: 495199606
CountryCode: US
TelephoneNumber: 6162523243
FaxNumber: 6162520260
Practice Location
Address1: 5950 METRO WAY SW
Address2:  
City: WYOMING
State: MI
PostalCode: 495199514
CountryCode: US
TelephoneNumber: 6162528100
FaxNumber: 6162528181
Other Information
ProviderEnumerationDate: 07/18/2006
LastUpdateDate: 12/08/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X5601003845MIY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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