Provider Demographics
NPI:1538105556
Name:KOTERBA, CAMILLE HELENA (MD)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:HELENA
Last Name:KOTERBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:KOTERBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:705 HOYT AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1751
Mailing Address - Country:US
Mailing Address - Phone:989-533-8480
Mailing Address - Fax:
Practice Address - Street 1:900 COOPER AVE STE 4400
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5182
Practice Address - Country:US
Practice Address - Phone:989-583-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047374208600000X
OK30413208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI060014865OtherRAILROAD MEDICARE
MI1000528OtherPRIORITY HEALTH
MI0983489OtherHEALTHPLUS
MI1538105556Medicaid
MI1006851OtherMCLAREN HEALTH PLAN
M020860OtherCHAMPVA
MI700B960280OtherBCBS
M020860OtherCHAMPVA
MI700B960280OtherBCBS