Provider Demographics
NPI:1649299223
Name:KOTA, LAURA J (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:J
Last Name:KOTA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1009 W GREEN STREET
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49047-1710
Mailing Address - Country:US
Mailing Address - Phone:269-945-1745
Mailing Address - Fax:269-948-9874
Practice Address - Street 1:1108 W STATE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-9711
Practice Address - Country:US
Practice Address - Phone:269-945-8080
Practice Address - Fax:269-945-8081
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-01-19
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Provider Licenses
StateLicense IDTaxonomies
MI4301080236207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM287500035Medicare PIN