Basic Information
Provider Information | |||||||||
NPI: | 1770731010 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CALOIA | ||||||||
FirstName: | ROYA | ||||||||
MiddleName: | ZOLNOOR | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ZOLNOOR | ||||||||
OtherFirstName: | ROYA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DO | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 38935 ANN ARBOR RD | ||||||||
Address2: | CREDENTIALING | ||||||||
City: | LIVONIA | ||||||||
State: | MI | ||||||||
PostalCode: | 481503397 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8888618740 | ||||||||
FaxNumber: | 8662506385 | ||||||||
Practice Location | |||||||||
Address1: | 18101 OAKWOOD BLVD | ||||||||
Address2: | EMERGENCY DEPT | ||||||||
City: | DEARBORN | ||||||||
State: | MI | ||||||||
PostalCode: | 481244089 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3135938780 | ||||||||
FaxNumber: | 3134362864 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/28/2008 | ||||||||
LastUpdateDate: | 05/14/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 5101017923 | MI | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207P00000X | 0102203003 | VA | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 1770731010 | 05 | MI |   | MEDICAID | 12236199 | 01 | MI | CAQH | OTHER |