Healthcare Provider Details

I. General information

NPI: 1871537340
Provider Name (Legal Business Name): MICHAEL DAVID KOTZEN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15243 VANOWEN ST SUITE 411B
VAN NUYS CA
91405-3605
US

IV. Provider business mailing address

15243 VANOWEN ST SUITE 411B
VAN NUYS CA
91405-3605
US

V. Phone/Fax

Practice location:
  • Phone: 818-782-3338
  • Fax: 818-782-3337
Mailing address:
  • Phone: 818-782-3338
  • Fax: 818-782-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: