Healthcare Provider Details

I. General information

NPI: 1265708887
Provider Name (Legal Business Name): TARA COTRONEO DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 E CANFIELD STREET
DETROIT MI
48201
US

IV. Provider business mailing address

540 E CANFIELD ST
DETROIT MI
48201-1928
US

V. Phone/Fax

Practice location:
  • Phone: 313-577-1405
  • Fax: 313-577-5890
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number6901009929
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: