Healthcare Provider Details

I. General information

NPI: 1609710037
Provider Name (Legal Business Name): KUZTOM LOOK KOUTOUR L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19369 YACAMA RD
DETROIT MI
48203-1608
US

IV. Provider business mailing address

607 SHELBY ST STE 700
DETROIT MI
48226-3282
US

V. Phone/Fax

Practice location:
  • Phone: 313-789-9809
  • Fax:
Mailing address:
  • Phone: 313-789-9809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: TAMARA WATTS
Title or Position: CEO
Credential:
Phone: 248-667-6492