Healthcare Provider Details

I. General information

NPI: 1619802048
Provider Name (Legal Business Name): ZOE GONSALVES M.B.B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DETROIT MEDICAL CENTER, GME OFFICE, 4201 ST. ANTOINE UHC-9C
DETROIT MI
48201
US

IV. Provider business mailing address

85 GENEVLEVE AVENUE
LA ROMAINE SAN FERNANDO
00000
TT

V. Phone/Fax

Practice location:
  • Phone: 313-210-7848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: