Healthcare Provider Details

I. General information

NPI: 1609636745
Provider Name (Legal Business Name): MR. AUSTIN LEE KOTCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 STANLEY ST
SAGINAW MI
48602-1061
US

IV. Provider business mailing address

1644 STANLEY ST
SAGINAW MI
48602-1061
US

V. Phone/Fax

Practice location:
  • Phone: 989-992-6261
  • Fax:
Mailing address:
  • Phone: 989-992-6261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: