Basic Information
Provider Information
NPI: 1851738041
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KUHTA
FirstName: TERESA
MiddleName: ANN
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 24 FRANK LLOYD WRIGHT DR STE J2000
Address2:  
City: ANN ARBOR
State: MI
PostalCode: 481059484
CountryCode: US
TelephoneNumber: 7347476766
FaxNumber: 7342223100
Practice Location
Address1: 5301 MCAULEY DR
Address2:  
City: YPSILANTI
State: MI
PostalCode: 481971051
CountryCode: US
TelephoneNumber: 7347123325
FaxNumber: 7347125525
Other Information
ProviderEnumerationDate: 05/28/2013
LastUpdateDate: 10/05/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/05/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X125-063073ILN Allopathic & Osteopathic PhysiciansPediatrics 
208000000X5101026099MIY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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