Healthcare Provider Details

I. General information

NPI: 1417982588
Provider Name (Legal Business Name): JEFFREY COUTURIER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 FORT STREET EMERGENCY MEDICINE DEPARTMENT
TRENTON MI
48183-4601
US

IV. Provider business mailing address

38935 ANN ARBOR RD CREDENTIALING/PAYER CONTRACTING
LIVONIA MI
48150-3397
US

V. Phone/Fax

Practice location:
  • Phone: 734-671-3883
  • Fax: 734-671-3546
Mailing address:
  • Phone: 734-632-0175
  • Fax: 734-632-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101009737
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: