Individual
DMITRI ALEXANDROVICH KAPOUSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1500 EAST MEDICAL CENTER DR, 2ND FLOOR TAUBMAN CTR RECP F, ANN ARBOR, MI 48109-5332
(734) 936-5738
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704299965
MI
Other
Enumeration date
10/30/2017
Last updated
12/19/2018
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