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General NPI Number Information
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NPI Number | 1629270822
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Entity Type | Individual
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Provider Name | CHAD KOTLARZ N.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 413 WAUKAZOO AVE
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City | PETOSKEY
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State | MI
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Zip | 49770-2619
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Country | US
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Telephone | 231-487-9462
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Fax |
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Provider Business Mailing Address
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Address Line | 2214 BIRCH VIEW DR
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City | KEWADIN
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State | MI
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Zip | 49648-9202
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Country | US
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Telephone | 231-487-9462
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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 | 099-0000056
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License Number State | VT
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