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General NPI Number Information
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NPI Number | 1417257551
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Entity Type | Individual
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Provider Name | JONATHAN KYULU NZOMA DO
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Gender | Male
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Dates
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Enumeration Date | 10/22/2010
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 27207 LAHSER RD STE 250B
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City | SOUTHFIELD
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State | MI
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Zip | 48034-8471
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Country | US
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Telephone | 313-327-2194
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Fax | 313-241-3127
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Provider Business Mailing Address
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Address Line | PO BOX 145
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City | NOVI
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State | MI
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Zip | 48376-0145
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Country | US
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Telephone | 313-327-2194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 5101020363
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License Number State | MI
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