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NPI Code Detail

MEDICARE: PINE SHORES OB/GYN ,P.C.

MEDICARE: PINE SHORES OB/GYN ,P.C.
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
1174400000XSpecialist

General Provider Information

NPI Number : 1932112281
Entity Type Code : Organization
Provider Name (Legal Business Name) : PINE SHORES OB/GYN ,P.C.
Provider Business Mailing Address
First Line : 1024 SUPERIOR ST
Second Line :
City : PORT HURON
State : MI
Zip : 48060-3748
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1024 SUPERIOR ST
Second Line :
City : PORT HURON
State : MI
Zip : 48060-3748
Country : US
Telephone Number : 810-985-9657
Fax Number : 810-985-3884
Authorized Official
Title or Position : PRESIDENT
Name : WILLIAM B. KUTSCHE
Credential : M.D.
Telephone Number : 810-364-7277
Provider Enumeration Date : 08/15/2006
Last Update Date : 08/22/2020

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Directions to “PINE SHORES OB/GYN ,P.C. ” Practice Location

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