Healthcare Provider Details

I. General information

NPI: 1649887555
Provider Name (Legal Business Name): MRS. DESPINA KOTSOYIANNIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30555 MICHIGAN AVE
WESTLAND MI
48186-5310
US

IV. Provider business mailing address

24403 COLONIAL DR
WOODHAVEN MI
48183-3726
US

V. Phone/Fax

Practice location:
  • Phone: 734-629-5000
  • Fax:
Mailing address:
  • Phone: 734-250-5890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: