MEDICARE: DR. ALAN PAUL KOTERBA M.D.

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	207R00000X	Internal Medicine Physician	4301087873	MI
2	207R00000X	Internal Medicine Physician	36121438	IL
3	207KA0200X	Allergy Physician	ME107004	FL

General Provider Information

NPI Number	:	1609994458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN PAUL KOTERBA M.D.

Provider Business Mailing Address
First Line	:	840 US HIGHWAY 1 STE 235
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-3835
Country	:	US
Telephone Number	:	561-626-2006
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 US HIGHWAY 1 STE 235
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-3835
Country	:	US
Telephone Number	:	561-626-2006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	09/27/2010

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