Provider Demographics
NPI:1053730523
Name:KAPSOKAVATHIS LLC
Entity type:Organization
Organization Name:KAPSOKAVATHIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:KAPSOKAVATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-206-2100
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:248-206-2101
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:248-206-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-14
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016538207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7357830001Medicare NSC
MIMI7613Medicare PIN