Healthcare Provider Details

I. General information

NPI: 1164474524
Provider Name (Legal Business Name): DE ANN K KUTZNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 S CLEVELAND AVE
SAINT JOSEPH MI
49085-3002
US

IV. Provider business mailing address

2690 S CLEVELAND AVE
SAINT JOSEPH MI
49085-3002
US

V. Phone/Fax

Practice location:
  • Phone: 269-428-2800
  • Fax: 269-428-7177
Mailing address:
  • Phone: 269-428-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDK054497
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: