Provider Demographics
NPI:1639422462
Name:MARK ZOHOURY
Entity Type:Organization
Organization Name:MARK ZOHOURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-740-8000
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2963045Medicaid
MI2963045Medicaid