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General NPI Number Information
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NPI Number | 1013516897
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Entity Type | Organization
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Legal Business Name | K AND L MEDICAL, LLC
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 03/14/2024
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Provider Practice Location Address
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Address Line | 12866 TROXLER AVE
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City | HIGHLAND
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State | IL
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Zip | 62249-2806
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Country | US
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Telephone | 618-900-1070
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Fax | 833-992-2437
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Provider Business Mailing Address
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Address Line | PO BOX 160
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City | TROY
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State | IL
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Zip | 62294-0160
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Country | US
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Telephone | 618-900-1070
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. KEVIN KOTH
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Credential | D.O.
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Telephone | 330-442-5815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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