Organization
CAROL KOTZAN MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL ANNE KOTZAN M.D. (PRESIDENT)
(815) 455-7200
Entity
Organization
Contact information
Practice address
360 STATION DR, SUITE 201, CRYSTAL LAKE, IL 60014-7978
(815) 455-7200
Mailing address
360 STATION DR, SUITE 201, CRYSTAL LAKE, IL 60014-7978
(815) 455-7200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036076689
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036076689
—
IL
01
—
5632584
BCBS
IL
Enumeration date
10/12/2012
Last updated
03/25/2013
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