MEDICARE: SUSAN L. KOTOFF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	ARNP9232212	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134197338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L. KOTOFF

Provider Business Mailing Address
First Line	:	2000 ISLAND BLVD
Second Line	:	#2608
City	:	AVENTURA
State	:	FL
Zip	:	33160-4957
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 W COMMERCIAL BLVD
Second Line	:	SUITE 5
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-3300
Country	:	US
Telephone Number	:	954-485-5666
Fax Number	:	954-484-1651

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	12/14/2015

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