Provider Demographics
NPI:1689740276
Name:COTLAR, MARK JACK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JACK
Last Name:COTLAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1623 LANCASTER CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1617
Mailing Address - Country:US
Mailing Address - Phone:317-876-7903
Mailing Address - Fax:317-334-9413
Practice Address - Street 1:1623 LANCASTER CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1617
Practice Address - Country:US
Practice Address - Phone:317-876-7903
Practice Address - Fax:317-334-9413
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01038105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine