=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326154543
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARI MICHELE ZUPKO DDS MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2355 COOLIDGE
-----------------------------------------------------
City | BERKLEY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48072-1550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-547-6080
-----------------------------------------------------
Fax | 248-547-6082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2355 COOLIDGE HWY
-----------------------------------------------------
City | BERKLEY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48072-1550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-547-6080
-----------------------------------------------------
Fax | 248-547-6082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 15847
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------