Provider Demographics
NPI:1871574533
Name:ZOHOURY, CAROLINE D (DO)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:D
Last Name:ZOHOURY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1743
Mailing Address - Country:US
Mailing Address - Phone:248-588-0400
Mailing Address - Fax:248-616-0846
Practice Address - Street 1:115 N ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1743
Practice Address - Country:US
Practice Address - Phone:248-588-0400
Practice Address - Fax:248-616-0846
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009948207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2799717Medicaid
5632471Medicare PIN
MI2799717Medicaid