Provider Demographics
NPI:1760473375
Name:KOTLER, MICHAEL DEAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEAN
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 1:1525 DICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123-2168
Mailing Address - Country:US
Mailing Address - Phone:504-818-0006
Mailing Address - Fax:504-818-0095
Practice Address - Street 1:1525 DICKORY AVE
Practice Address - Street 2:
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-2168
Practice Address - Country:US
Practice Address - Phone:504-818-0006
Practice Address - Fax:504-818-0095
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08650R207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1916633Medicaid
E58892Medicare UPIN
LA1916633Medicaid