Doctor Name: | DR. TIMOTHY A KOLTUNIAK |
NPI Number: | 1265767529 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 6301008526 |
Business Practice Address: | 8303 Platt Rd. Center For Forensic Psychiatry Saline, MI - 481769773 |
Business Phone Number: | 7342954523 |
Business Fax Number: | 7344291817 |
Mailing Address: | 8303 Platt Rd., Center For Forensic Psychiatry SALINE |
State: | MI |
Postal Code: | 481769773 |
Phone Number: | 7342954523 |
Fax Number: | 7344291817 |
NPI Enumeration Date: | 10/05/2009 |
NPI Last Update Date: | 10/05/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 6301008526 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |