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NPI Code Detail

MEDICARE: DR. LINDSEY V. KOTAGAL M.D.

MEDICARE: DR. LINDSEY V. KOTAGAL 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
1390200000XStudent in an Organized Health Care Education/Training Program4301096345MI
2207Q00000XFamily Medicine Physician4301096345MI

General Provider Information

NPI Number : 1629380530
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LINDSEY V. KOTAGAL M.D.
Provider Business Mailing Address
First Line : 3174 PACKARD ST
Second Line :
City : ANN ARBOR
State : MI
Zip : 48108-1947
Country : US
Telephone Number : 734-926-4900
Fax Number :
Provider Business Practice Location Address
First Line : 501 N MAPLE RD
Second Line :
City : ANN ARBOR
State : MI
Zip : 48103-2827
Country : US
Telephone Number : 734-926-4900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2010
Last Update Date : 02/17/2020

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