Provider Demographics
NPI:1073180139
Name:KOTIS, MICHELE CHRISTINE (NP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:CHRISTINE
Last Name:KOTIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13458 W 83RD PL
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9169
Mailing Address - Country:US
Mailing Address - Phone:219-775-3839
Mailing Address - Fax:
Practice Address - Street 1:9307 CALUMET AVE STE D1
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2892
Practice Address - Country:US
Practice Address - Phone:121-970-3939
Practice Address - Fax:219-703-6704
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011185A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty