Provider Demographics
NPI:1174530232
Name:ZOHOURY, MARK R (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:ZOHOURY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1950 E WATTLES RD
Mailing Address - Street 2:STE 101
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-5099
Mailing Address - Country:US
Mailing Address - Phone:248-740-8000
Mailing Address - Fax:248-740-1355
Practice Address - Street 1:1950 E WATTLES RD
Practice Address - Street 2:STE 101
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-5099
Practice Address - Country:US
Practice Address - Phone:248-740-8000
Practice Address - Fax:248-740-1355
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-10-31
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Provider Licenses
StateLicense IDTaxonomies
MI5101010768207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2963045Medicaid
MI2963045Medicaid
F62881Medicare UPIN