Provider Demographics
NPI:1568545895
Name:KOTWAL, RUSS STEVEN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:RUSS
Middle Name:STEVEN
Last Name:KOTWAL
Suffix:
Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:6400 1ST INFANTRY BRIGADE LOOP
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31905-6499
Mailing Address - Country:US
Mailing Address - Phone:706-545-4545
Mailing Address - Fax:706-545-5762
Practice Address - Street 1:6400 1ST INFANTRY BRIGADE LOOP
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31905-6499
Practice Address - Country:US
Practice Address - Phone:706-545-4545
Practice Address - Fax:706-545-5762
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA045076207Q00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAVAD000Medicare UPIN