Provider Demographics
NPI:1861530438
Name:ZOMERLEI, TERRI A (MD)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:A
Last Name:ZOMERLEI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4070 LAKE DRIVE SE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-464-4420
Mailing Address - Fax:616-464-4354
Practice Address - Street 1:4660 S HAGADORN RD STE 600
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5383
Practice Address - Country:US
Practice Address - Phone:517-267-2460
Practice Address - Fax:517-884-8602
Is Sole Proprietor?:No
Enumeration Date:2007-02-03
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH57208200000X
MI4301117082208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery