Provider Demographics
NPI:1518395193
Name:DR. BOB COUNTRY DOCTOR PLLC
Entity Type:Organization
Organization Name:DR. BOB COUNTRY DOCTOR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:KUFFA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-709-7580
Mailing Address - Street 1:1306 KENT RD
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-8528
Mailing Address - Country:US
Mailing Address - Phone:248-627-6171
Mailing Address - Fax:248-627-6171
Practice Address - Street 1:1306 KENT RD
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-8528
Practice Address - Country:US
Practice Address - Phone:248-627-6171
Practice Address - Fax:248-627-6171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty