Healthcare Provider Details

I. General information

NPI: 1942513239
Provider Name (Legal Business Name): SUHEL KOTWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2010
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 W 119TH ST STE 410
LEAWOOD KS
66209-3721
US

IV. Provider business mailing address

5701 W 119TH ST STE 410
OVERLAND PARK KS
66209-3721
US

V. Phone/Fax

Practice location:
  • Phone: 913-345-6901
  • Fax:
Mailing address:
  • Phone: 913-345-6901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number125.056020
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number04-44780
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberP76751
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number04-44780
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number04-44780
License Number StateKS
# 6
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2012025714
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: