Healthcare Provider Details

I. General information

NPI: 1083126437
Provider Name (Legal Business Name): DANIEL KOTSIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6555 W MAPLE RD
WEST BLOOMFIELD MI
48322-4926
US

IV. Provider business mailing address

6555 W MAPLE RD
WEST BLOOMFIELD MI
48322-4926
US

V. Phone/Fax

Practice location:
  • Phone: 248-592-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801101779
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: