MEDICARE: HARRY COTLER INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	PO3942	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PO3942	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1033307285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRY COTLER INC.

Provider Business Mailing Address
First Line	:	PO BOX 799
Second Line	:
City	:	ESTERO
State	:	FL
Zip	:	33929-0799
Country	:	US
Telephone Number	:	907-398-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	23421 WALDEN CENTER DR.
Second Line	:	STE. 100
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-4911
Country	:	US
Telephone Number	:	239-444-0700
Fax Number	:	239-444-0900

Authorized Official
Title or Position	:	OWNER/PRESIDENT/PHYSICIAN
Name	:	HARRY COTLER
Credential	:	DPM
Telephone Number	:	239-444-0700

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	03/17/2018

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