Healthcare Provider Details

I. General information

NPI: 1619976321
Provider Name (Legal Business Name): BERNARD KOTTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 MAYFIELD RD SUITE# 244
MAYFIELD HEIGHTS OH
44124-2270
US

IV. Provider business mailing address

6801 MAYFIELD RD SUITE# 244
MAYFIELD HEIGHTS OH
44124-2270
US

V. Phone/Fax

Practice location:
  • Phone: 440-442-0886
  • Fax: 440-442-0807
Mailing address:
  • Phone: 440-442-0886
  • Fax: 440-442-0807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35041771
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: