=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104074384
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHELDON PAUL KOTTLE M.D., MPH, FACP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2008
-----------------------------------------------------
Last Update Date | 04/21/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6420 E HUMMINGBIRD LN
-----------------------------------------------------
City | PARADISE VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85253-3655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-483-9777
-----------------------------------------------------
Fax | 480-951-8278
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6420 E HUMMINGBIRD LN
-----------------------------------------------------
City | PARADISE VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85253-3655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-483-9777
-----------------------------------------------------
Fax | 480-951-8278
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 21087
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | MD.INT
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------