Individual
THOMAS E KOTTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
640 JACKSON STREET, MC 11102H, ST PAUL, MN 55101-2502
(651) 254-5175
(651) 254-1603
Mailing address
640 JACKSON ST, MAIL STOP 11102H, SAINT PAUL, MN 55101-2502
(651) 254-5175
(651) 254-1603
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
24324
MN
207RC0000X
Cardiovascular Disease Physician
47187-0Z0
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363773500
—
MN
Enumeration date
02/27/2006
Last updated
05/12/2008
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