Healthcare Provider Details

I. General information

NPI: 1356491179
Provider Name (Legal Business Name): ADAM J KOTKIEWICZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 09/28/2025
Certification Date: 09/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 S CONGRESS AVE STE 200
PALM SPRINGS FL
33461-2171
US

IV. Provider business mailing address

PO BOX 160748
ALTAMONTE SPRINGS FL
32716-0748
US

V. Phone/Fax

Practice location:
  • Phone: 561-253-3980
  • Fax: 561-253-3985
Mailing address:
  • Phone: 561-253-3980
  • Fax: 561-253-3985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberOS013866
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS013866
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberOS013866
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberOS17394
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: