Healthcare Provider Details

I. General information

NPI: 1003224601
Provider Name (Legal Business Name): NICHOLAS DAVID CAPAUL M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2014
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S MONROE ST
MONROE MI
48161-1430
US

IV. Provider business mailing address

750 S MONROE ST
MONROE MI
48161-1430
US

V. Phone/Fax

Practice location:
  • Phone: 734-639-2262
  • Fax: 734-264-4114
Mailing address:
  • Phone: 734-639-2262
  • Fax: 734-264-4114

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: