Healthcare Provider Details

I. General information

NPI: 1770036907
Provider Name (Legal Business Name): KEVIN DOERZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2016
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N MICHIGAN AVE
SAGINAW MI
48602-4732
US

IV. Provider business mailing address

PO BOX 741
STANDISH MI
48658-0741
US

V. Phone/Fax

Practice location:
  • Phone: 989-401-9033
  • Fax:
Mailing address:
  • Phone: 989-846-9631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: