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General NPI Number Information
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NPI Number | 1619967957
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Entity Type | Individual
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Provider Name | TRACY ANN KOTNIK M.D., F.A.A.F.P.
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Gender | Female
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 07/02/2010
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Provider Practice Location Address
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Address Line | 2859 AARONWOOD AVE NE UNIT 3
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City | MASSILLON
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State | OH
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Zip | 44646-2371
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Country | US
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Telephone | 330-832-2280
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Fax | 330-832-4732
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Provider Business Mailing Address
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Address Line | 3218 WOODRIDGE AVE NW
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City | CANTON
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State | OH
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Zip | 44718-3448
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Country | US
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Telephone | 330-456-5472
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35062187K
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License Number State | OH
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