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NPI Code Detail

MEDICARE: MRS. CYNTHIA LEE STOVALL COTA

MEDICARE: MRS. CYNTHIA LEE STOVALL COTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171W00000XContractor5202002631MI
2172V00000XCommunity Health Worker5202002631MI

General Provider Information

NPI Number : 1225277254
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CYNTHIA LEE STOVALL COTA
Provider Business Mailing Address
First Line : 34323 WEBER RD
Second Line :
City : RICHMOND
State : MI
Zip : 48062-3011
Country : US
Telephone Number : 810-392-3757
Fax Number :
Provider Business Practice Location Address
First Line : 34323 WEBER RD
Second Line :
City : RICHMOND
State : MI
Zip : 48062-3011
Country : US
Telephone Number : 810-392-3757
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2009
Last Update Date : 02/15/2009

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