Provider Demographics
NPI:1730197724
Name:ZELENAK, LAURA ERMAN (DO)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ERMAN
Last Name:ZELENAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6672 NEWARK RD
Mailing Address - Street 2:
Mailing Address - City:IMLAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48444-9657
Mailing Address - Country:US
Mailing Address - Phone:810-724-0591
Mailing Address - Fax:810-724-0272
Practice Address - Street 1:6672 NEWARK RD
Practice Address - Street 2:
Practice Address - City:IMLAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48444-9657
Practice Address - Country:US
Practice Address - Phone:810-724-0591
Practice Address - Fax:810-724-0272
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4602623Medicaid
MI4602623Medicaid
ON45020004Medicare ID - Type Unspecified