MEDICARE: PATRICIA KOTYLO 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	38760	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000085801	OTHER	IN	ANTHEM PROVIDER NUMBER

General Provider Information

NPI Number	:	1639172091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA KOTYLO M.D.

Provider Business Mailing Address
First Line	:	411 S OAKWOOD DR
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-2047
Country	:	US
Telephone Number	:	317-889-8452
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 S OAKWOOD DR
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-2047
Country	:	US
Telephone Number	:	317-889-8452
Fax Number	:

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	04/24/2018

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