Healthcare Provider Details

I. General information

NPI: 1770110876
Provider Name (Legal Business Name): ZOE SIOBHAN BATES CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19714 E 10 MILE RD
SAINT CLAIR SHORES MI
48080-1064
US

IV. Provider business mailing address

2073 HAMPTON RD
GROSSE POINTE WOODS MI
48236-1325
US

V. Phone/Fax

Practice location:
  • Phone: 586-779-9400
  • Fax:
Mailing address:
  • Phone: 313-799-0905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number4704242436
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704242436
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: