Basic Information
| Provider Information | |||||||||
| NPI: | 1366544058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZILLI | ||||||||
| FirstName: | JANAINA | ||||||||
| MiddleName: | MATTEUSSI | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MATTEUSSI | ||||||||
| OtherFirstName: | JANAINA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 50505 SCHOENHERR RD | ||||||||
| Address2: | STE 340 | ||||||||
| City: | SHELBY TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483153140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867318400 | ||||||||
| FaxNumber: | 5867318406 | ||||||||
| Practice Location | |||||||||
| Address1: | 28001 HARPER AVE | ||||||||
| Address2: | |||||||||
| City: | ST CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480811561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867727180 | ||||||||
| FaxNumber: | 5862790033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2006 | ||||||||
| LastUpdateDate: | 07/27/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 4301081453 | MI | N | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | 4301081453 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.