Provider Demographics
NPI:1689788747
Name:KOTWAL, RENU (MD)
Entity Type:Individual
Prefix:
First Name:RENU
Middle Name:
Last Name:KOTWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5240 E GALBRAITH RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2877
Mailing Address - Country:US
Mailing Address - Phone:513-442-0027
Mailing Address - Fax:513-442-0225
Practice Address - Street 1:5240 E GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2877
Practice Address - Country:US
Practice Address - Phone:513-442-0027
Practice Address - Fax:513-442-0225
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0811262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2328332Medicaid
OH260051987OtherMEDICARE RAILROAD
OHKO4093413Medicare ID - Type Unspecified
OH2328332Medicaid