Basic Information
| Provider Information | |||||||||
| NPI: | 1942492772 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CAROL A. KOTZAN, M.D., S. C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 STATION DRVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CRYSTAL LAKE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600147978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154557200 | ||||||||
| FaxNumber: | 8154559256 | ||||||||
| Practice Location | |||||||||
| Address1: | 5911 NORTHWEST HWY | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | CRYSTAL LAKE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600148065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154557200 | ||||||||
| FaxNumber: | 8154559256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2007 | ||||||||
| LastUpdateDate: | 04/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | KOTZAN | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8154557200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 042617706 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.