Healthcare Provider Details

I. General information

NPI: 1528149788
Provider Name (Legal Business Name): JOEL KUTZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CROSS CREEK PKWY STE. 200
AUBURN HILLS MI
48326-2776
US

IV. Provider business mailing address

40686 SAINT LOUIS DR
CLINTON TOWNSHIP MI
48038-7129
US

V. Phone/Fax

Practice location:
  • Phone: 248-377-8000
  • Fax: 248-377-2929
Mailing address:
  • Phone: 586-822-4796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601004522
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5601004522
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: