Provider Demographics
NPI:1174581607
Name:ZIELASKOWSKI, LORNE ALEC (DPM)
Entity type:Individual
Prefix:
First Name:LORNE
Middle Name:ALEC
Last Name:ZIELASKOWSKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 LONG RAPIDS PLZ
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1375
Mailing Address - Country:US
Mailing Address - Phone:989-354-3309
Mailing Address - Fax:989-354-9190
Practice Address - Street 1:321 LONG RAPIDS PLZ
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1375
Practice Address - Country:US
Practice Address - Phone:989-354-3309
Practice Address - Fax:989-354-9190
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILZ002070213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MILZ002070OtherMICHIGAN LICENSE NUMBER
MI4728723Medicaid
MILZ002070OtherMICHIGAN LICENSE NUMBER
MI0N21940008Medicare ID - Type Unspecified