Healthcare Provider Details

I. General information

NPI: 1427365782
Provider Name (Legal Business Name): JOHN KOTSCH M.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

4131 NW 28TH LN STE 3A
GAINESVILLE FL
32606-6665
US

IV. Provider business mailing address

2939 NW 6TH DR
GAINESVILLE FL
32609-0905
US

V. Phone/Fax

Practice location:
  • Phone: 352-278-4760
  • Fax:
Mailing address:
  • Phone: 352-278-4760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 2877
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: