Provider Demographics
NPI:1609805985
Name:KOTLER, HOWARD SHANE (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:SHANE
Last Name:KOTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 W ADAMS ST APT 509
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3000
Mailing Address - Country:US
Mailing Address - Phone:312-622-3500
Mailing Address - Fax:
Practice Address - Street 1:843 W ADAMS ST APT 509
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3000
Practice Address - Country:US
Practice Address - Phone:312-622-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082174207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082174Medicaid
ILL32375Medicare PIN
ILF70611Medicare UPIN