Provider Demographics
NPI:1467113589
Name:KOTLIN, DAKOTA JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:DAKOTA
Middle Name:JOHN
Last Name:KOTLIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-3230
Mailing Address - Fax:614-293-4030
Practice Address - Street 1:181 TAYLOR AVE STE 1102
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1779
Practice Address - Country:US
Practice Address - Phone:614-293-3230
Practice Address - Fax:614-293-4030
Is Sole Proprietor?:No
Enumeration Date:2022-01-02
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008239RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant