Provider Demographics
NPI:1700038023
Name:KOTEK, LARRY WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:WILLIAM
Last Name:KOTEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7700 FRANCE AVE S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5847
Mailing Address - Country:US
Mailing Address - Phone:952-922-7000
Mailing Address - Fax:952-920-3333
Practice Address - Street 1:7700 FRANCE AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5847
Practice Address - Country:US
Practice Address - Phone:952-922-7000
Practice Address - Fax:952-920-3333
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN22030207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine