Provider Demographics
NPI:1548796543
Name:ZAMORA-SIFUENTES, JOSE LUIS (DO)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:ZAMORA-SIFUENTES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19251 MACK AVE STE 335
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2895
Mailing Address - Country:US
Mailing Address - Phone:313-343-3329
Mailing Address - Fax:313-343-7784
Practice Address - Street 1:22101 MOROSS RD
Practice Address - Street 2:PROFESSIONAL BUILDING 2, SUITE 50
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2148
Practice Address - Country:US
Practice Address - Phone:313-343-7784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101023043207R00000X
MI5101025436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine