Basic Information
Provider Information
NPI: 1730717307
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KAPS
FirstName: ZOE
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: ANTONIOU
OtherFirstName: ZOE
OtherMiddleName: M
OtherNamePrefix: MS.
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: HENRY FORD WYANDOTTE HOSPITAL, MEDICAL EDUCATION DEPT
Address2: 2333 BIDDLE AVE.
City: WYANDOTTE
State: MI
PostalCode: 48192
CountryCode: US
TelephoneNumber: 7342468004
FaxNumber:  
Practice Location
Address1: 2333 BIDDLE AVE
Address2:  
City: WYANDOTTE
State: MI
PostalCode: 481924668
CountryCode: US
TelephoneNumber: 7342468004
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/30/2020
LastUpdateDate: 06/29/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/29/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X4351046412MIY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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