Healthcare Provider Details

I. General information

NPI: 1508916800
Provider Name (Legal Business Name): MICHELLE KRISTINE KUT P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25599 KELLY RD SUITE A
ROSEVILLE MI
48066-4975
US

IV. Provider business mailing address

25599 KELLY RD SUITE A
ROSEVILLE MI
48066-4975
US

V. Phone/Fax

Practice location:
  • Phone: 586-772-6000
  • Fax: 586-772-7700
Mailing address:
  • Phone: 586-772-6000
  • Fax: 586-772-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5601003976
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: