Provider Demographics
NPI:1013516897
Name:K AND L MEDICAL, LLC
Entity Type:Organization
Organization Name:K AND L MEDICAL, LLC
Other - Org Name:KOTH ORTHOPEDICS AND SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-442-5815
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-0160
Mailing Address - Country:US
Mailing Address - Phone:618-900-1070
Mailing Address - Fax:
Practice Address - Street 1:12866 TROXLER AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-2806
Practice Address - Country:US
Practice Address - Phone:618-900-1070
Practice Address - Fax:833-992-2437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty