Healthcare Provider Details

I. General information

NPI: 1669276325
Provider Name (Legal Business Name): HENRY JOHN KOTLINSKI II DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W. 86TH STREET MEDICAL EDUCATION 1 NORTH
INDIANAPOLIS IN
46260
US

IV. Provider business mailing address

2001 W. 86TH STREET MEDICAL EDUCATION 1 NORTH
INDIANAPOLIS IN
46260
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-6399
  • Fax: 317-338-6359
Mailing address:
  • Phone: 317-338-6399
  • Fax: 317-338-6359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: