Healthcare Provider Details

I. General information

NPI: 1770773772
Provider Name (Legal Business Name): ERIN D BIERSTETEL C.O.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 S GILPIN ST
DENVER CO
80209-2616
US

IV. Provider business mailing address

427 S GILPIN ST
DENVER CO
80209-2616
US

V. Phone/Fax

Practice location:
  • Phone: 517-927-6558
  • Fax:
Mailing address:
  • Phone: 517-927-6558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number5202006546
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: