Healthcare Provider Details

I. General information

NPI: 1013946169
Provider Name (Legal Business Name): GEORGE KOTLEWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1961 WEHRLE DR
WILLIAMSVILLE NY
14221-8460
US

IV. Provider business mailing address

1961 WEHRLE DR
WILLIAMSVILLE NY
14221-8460
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-4242
  • Fax:
Mailing address:
  • Phone: 716-632-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number118551
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: