Individual
DR. MICHAEL ROY KOTELES JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 BODIN CIR, TRAVIS AFB, CA 94535-1809
(707) 423-7963
Mailing address
101 BODIN CIR, TRAVIS AFB, CA 94535-1809
(707) 423-7963
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4302089244
MI
207R00000X
Internal Medicine Physician
MD00044508
WA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
C55542
CA
Other
Enumeration date
12/05/2005
Last updated
04/26/2013
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