MEDICARE: RENEE CONTE COTA/L

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	171W00000X	Contractor	5202006788	MI

General Provider Information

NPI Number	:	1730452996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE CONTE COTA/L

Provider Business Mailing Address
First Line	:	55501 CLEVELAND
Second Line	:
City	:	SHELBY TWP
State	:	MI
Zip	:	48316-1117
Country	:	US
Telephone Number	:	248-321-4551
Fax Number	:

Provider Business Practice Location Address
First Line	:	55501 CLEVELAND
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48316-1117
Country	:	US
Telephone Number	:	248-321-4551
Fax Number	:

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

Provider Enumeration Date	:	02/20/2012
Last Update Date	:	02/20/2012

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