Healthcare Provider Details

I. General information

NPI: 1235793514
Provider Name (Legal Business Name): MAKENZIE MITCHELL KOTHMANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W HWY 6
WACO TX
76710-5591
US

IV. Provider business mailing address

809 WOODLAND WEST DR
WOODWAY TX
76712-3415
US

V. Phone/Fax

Practice location:
  • Phone: 254-772-5454
  • Fax:
Mailing address:
  • Phone: 325-805-1316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberBP10067117
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberU3567
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: