Provider Demographics
NPI:1891184602
Name:KOTZ, KATHERINE (CPNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:KOTZ
Suffix:
Gender:F
Credentials:CPNP
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 ST. ANTIONE UHC 5D
Mailing Address - Street 2:UNIVERSITY PEDIATRICIANS
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-966-5051
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:3901 BEAUBIEN
Practice Address - Street 2:CHILDREN'S HOSPITAL OF MI/UNIVERSITY PEDIATRICIANS
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5515
Practice Address - Fax:313-745-5237
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704258161363LA2100X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics