Basic Information
| Provider Information | |||||||||
| NPI: | 1801881909 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZETOUNA | ||||||||
| FirstName: | MELISSA | ||||||||
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| Credential: | P.A.-C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31313 NORTHWESTERN HWY | ||||||||
| Address2: | STE 203 | ||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483342577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488800123 | ||||||||
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| Practice Location | |||||||||
| Address1: | 18 MARKET ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | MOUNT CLEMENS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480437403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867832222 | ||||||||
| FaxNumber: | 5867836280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 07/12/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 5601004426 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.