Healthcare Provider Details

I. General information

NPI: 1154205961
Provider Name (Legal Business Name): MIA KOCHANEK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30137 TURTLE CREEK CIR
NEW HUDSON MI
48165-0008
US

IV. Provider business mailing address

30137 TURTLE CREEK CIR
NEW HUDSON MI
48165-0008
US

V. Phone/Fax

Practice location:
  • Phone: 734-730-8230
  • Fax:
Mailing address:
  • Phone: 734-730-8230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: