Healthcare Provider Details

I. General information

NPI: 1689788747
Provider Name (Legal Business Name): RENU KOTWAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 DOLWICK DR
ERLANGER KY
41018-2774
US

IV. Provider business mailing address

5240 E GALBRAITH RD
CINCINNATI OH
45236-2877
US

V. Phone/Fax

Practice location:
  • Phone: 859-466-0115
  • Fax: 859-287-3297
Mailing address:
  • Phone: 513-442-0027
  • Fax: 513-442-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.081126
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberTP249
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: