Healthcare Provider Details

I. General information

NPI: 1376523506
Provider Name (Legal Business Name): KATHRYN KOCHES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22074 MICHIGAN AVE
DEARBORN MI
48124-2353
US

IV. Provider business mailing address

22074 MICHIGAN AVE
DEARBORN MI
48124-2353
US

V. Phone/Fax

Practice location:
  • Phone: 313-565-9510
  • Fax: 313-565-4410
Mailing address:
  • Phone: 313-565-9510
  • Fax: 313-565-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704101055
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: