Healthcare Provider Details

I. General information

NPI: 1548451800
Provider Name (Legal Business Name): DANELLE A KUTNER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13355 E 10 MILE RD
WARREN MI
48089-2048
US

IV. Provider business mailing address

PO BOX 452317
SUNRISE FL
33345-2317
US

V. Phone/Fax

Practice location:
  • Phone: 586-759-7300
  • Fax:
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101017447
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS11293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: