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General NPI Number Information
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NPI Number | 1518395193
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Entity Type | Organization
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Legal Business Name | DR. BOB COUNTRY DOCTOR PLLC
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Dates
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Enumeration Date | 10/17/2013
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 1306 KENT RD
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City | ORTONVILLE
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State | MI
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Zip | 48462-8528
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Country | US
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Telephone | 248-627-6171
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Fax | 248-627-6171
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Provider Business Mailing Address
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Address Line | 1306 KENT RD
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City | ORTONVILLE
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State | MI
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Zip | 48462-8528
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Country | US
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Telephone | 248-627-6171
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Fax | 248-627-6171
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. ROBERT K KUFFA
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Credential | D.O.
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Telephone | 248-709-7580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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