Provider Demographics
NPI:1336122720
Name:DEOL, ZOE K (MD)
Entity Type:Individual
Prefix:DR
First Name:ZOE
Middle Name:K
Last Name:DEOL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6601 ALDEN DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-2009
Mailing Address - Country:US
Mailing Address - Phone:248-561-3021
Mailing Address - Fax:
Practice Address - Street 1:15255 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2487
Practice Address - Country:US
Practice Address - Phone:734-785-8916
Practice Address - Fax:734-785-8907
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301066409208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H78048Medicare UPIN
MI4494482Medicare ID - Type Unspecified