Healthcare Provider Details

I. General information

NPI: 1467240747
Provider Name (Legal Business Name): ASHLEY RENEE KOT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35455 GARFIELD RD
CLINTON TWP MI
48035-2500
US

IV. Provider business mailing address

4161 SNOAL LN
SHELBY TWP MI
48316-1450
US

V. Phone/Fax

Practice location:
  • Phone: 586-690-5230
  • Fax:
Mailing address:
  • Phone: 586-690-5230
  • Fax: 586-690-5230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451024237
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: