Healthcare Provider Details

I. General information

NPI: 1598576431
Provider Name (Legal Business Name): KAWECHE KATUNDU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2366 OAK VALLEY DR
ANN ARBOR MI
48103-8944
US

IV. Provider business mailing address

303 E KEARSLEY ST
FLINT MI
48502-1907
US

V. Phone/Fax

Practice location:
  • Phone: 877-227-8823
  • Fax: 313-578-6393
Mailing address:
  • Phone: 810-762-3420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704318030
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number470431803
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: