Healthcare Provider Details

I. General information

NPI: 1871574533
Provider Name (Legal Business Name): CAROLINE D ZOHOURY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N ROCHESTER RD
CLAWSON MI
48017-1743
US

IV. Provider business mailing address

115 N ROCHESTER RD
CLAWSON MI
48017-1743
US

V. Phone/Fax

Practice location:
  • Phone: 248-588-0400
  • Fax: 248-616-0846
Mailing address:
  • Phone: 248-588-0400
  • Fax: 248-616-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101009948
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: