Healthcare Provider Details

I. General information

NPI: 1538105556
Provider Name (Legal Business Name): CAMILLE HELENA KOTERBA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA KOTERBA MD

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 COOPER AVE STE 4400
SAGINAW MI
48602-5182
US

IV. Provider business mailing address

705 HOYT AVE
SAGINAW MI
48607-1751
US

V. Phone/Fax

Practice location:
  • Phone: 989-583-0000
  • Fax:
Mailing address:
  • Phone: 989-533-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301047374
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number30413
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: