Healthcare Provider Details

I. General information

NPI: 1699060897
Provider Name (Legal Business Name): KIRTI KOCHE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2493 FOREST MEADOWS CT SE
GRAND RAPIDS MI
49546-7931
US

IV. Provider business mailing address

2493 FOREST MEADOWS CT SE
GRAND RAPIDS MI
49546-7931
US

V. Phone/Fax

Practice location:
  • Phone: 616-301-4623
  • Fax:
Mailing address:
  • Phone: 616-301-4623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: