Provider Demographics
NPI:1013105972
Name:MICHAEL D. KOTZEN, INC.
Entity Type:Organization
Organization Name:MICHAEL D. KOTZEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KOTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-452-9902
Mailing Address - Street 1:12520 MAGNOLIA BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2355
Mailing Address - Country:US
Mailing Address - Phone:818-452-9902
Mailing Address - Fax:818-452-9902
Practice Address - Street 1:12520 MAGNOLIA BLVD STE 304
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2355
Practice Address - Country:US
Practice Address - Phone:818-452-9902
Practice Address - Fax:818-452-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4686213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6049890001Medicare NSC