Individual
ETHAN COUCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
416 CONNABLE AVE, PETOSKEY, MI 49770-2212
(231) 487-7969
Mailing address
15235 HOUGH RD, ALLENTON, MI 48002-3613
(810) 656-1884
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101023447
MI
Other
Enumeration date
04/13/2017
Last updated
11/29/2022
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