MEDICARE: ANN MARIE KAUTZ-MARKLEY OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901003952	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235215864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARIE KAUTZ-MARKLEY OD

Provider Business Mailing Address
First Line	:	4499 TOWN CENTER PKWY
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48532-3425
Country	:	US
Telephone Number	:	810-733-7111
Fax Number	:	810-733-7141

Provider Business Practice Location Address
First Line	:	4499 TOWN CENTER PKWY
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48532-3425
Country	:	US
Telephone Number	:	810-733-7111
Fax Number	:	810-733-7141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	10/12/2016

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