1659680668 NPI number — MRS. KATHARINE ANN ROHROFF COTA

Table of content: MRS. KATHARINE ANN ROHROFF COTA (NPI 1659680668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659680668 NPI number — MRS. KATHARINE ANN ROHROFF COTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROHROFF
Provider First Name:
KATHARINE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
COTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROHROFF
Provider Other First Name:
KATHARINE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
COTA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1659680668
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13712 TRENTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHGATE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48195-1828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-284-1574
Provider Business Mailing Address Fax Number:
734-284-1574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13712 TRENTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHGATE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48195-1828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-284-1574
Provider Business Practice Location Address Fax Number:
734-284-1574
Provider Enumeration Date:
09/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X , with the licence number:  L1571023 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , with the licence number: L1571023 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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