Provider Demographics
NPI:1568664134
Name:KAPSOKAVATHIS, MICHAEL CLIFTON (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CLIFTON
Last Name:KAPSOKAVATHIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1268 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-3082
Mailing Address - Country:US
Mailing Address - Phone:248-206-2100
Mailing Address - Fax:586-279-5864
Practice Address - Street 1:700 N OLD WOODWARD AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-1322
Practice Address - Country:US
Practice Address - Phone:248-206-2100
Practice Address - Fax:586-279-5864
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016538207X00000X
MA242354207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI7613Medicare PIN