Individual
JACOB D KOTZIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-3152
(612) 904-4218
Mailing address
701 PARK AVE, MINNEAPOLIS, MN 55415-1623
(612) 873-6005
(612) 630-8242
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
074418
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16F52KR
BLUE CROSS BLUE SHIELD
MN
01
—
P00352505
MEDICARE RAILROAD
MN
Enumeration date
05/26/2006
Last updated
12/05/2007
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