Provider Demographics
NPI:1366544058
Name:ZILLI, JANAINA MATTEUSSI (MD)
Entity type:Individual
Prefix:
First Name:JANAINA
Middle Name:MATTEUSSI
Last Name:ZILLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANAINA
Other - Middle Name:
Other - Last Name:MATTEUSSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:50505 SCHOENHERR RD
Mailing Address - Street 2:STE 340
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-3140
Mailing Address - Country:US
Mailing Address - Phone:586-731-8400
Mailing Address - Fax:586-731-8406
Practice Address - Street 1:28001 HARPER AVE
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1561
Practice Address - Country:US
Practice Address - Phone:586-772-7180
Practice Address - Fax:586-279-0033
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081453208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN67900005Medicare PIN