Provider Demographics
NPI:1700091345
Name:PETER ZADVINSKIS MD PC
Entity type:Organization
Organization Name:PETER ZADVINSKIS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:Z
Authorized Official - Last Name:ZADVINSKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-592-5507
Mailing Address - Street 1:705 OAK ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-3107
Mailing Address - Country:US
Mailing Address - Phone:231-592-5507
Mailing Address - Fax:231-592-4841
Practice Address - Street 1:705 OAK ST
Practice Address - Street 2:SUITE #5
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-3107
Practice Address - Country:US
Practice Address - Phone:231-592-5507
Practice Address - Fax:231-592-4841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPZ056351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00230491OtherRR MCARE
MI1105434031OtherBCBS
MI108153OtherPREFERRED CHOICES
MI=========OtherPRIORITY HEALTH
MI0P17460Medicare ID - Type Unspecified
MI1105434031OtherBCBS