Healthcare Provider Details

I. General information

NPI: 1497332498
Provider Name (Legal Business Name): EITHAN KOTKOWSKI MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 PLEASANTON RD
SAN ANTONIO TX
78214-1345
US

IV. Provider business mailing address

720 PLEASANTON RD
SAN ANTONIO TX
78214-1343
US

V. Phone/Fax

Practice location:
  • Phone: 210-921-3800
  • Fax:
Mailing address:
  • Phone: 210-921-3800
  • Fax: 210-334-2861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberV9644
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: