Provider Demographics
NPI:1629270822
Name:KOTLARZ, CHAD (NMD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:KOTLARZ
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 BIRCH VIEW DR
Mailing Address - Street 2:
Mailing Address - City:KEWADIN
Mailing Address - State:MI
Mailing Address - Zip Code:49648-9202
Mailing Address - Country:US
Mailing Address - Phone:231-487-9462
Mailing Address - Fax:
Practice Address - Street 1:413 WAUKAZOO AVE
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2619
Practice Address - Country:US
Practice Address - Phone:231-487-9462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099-0000056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine