Individual
DR. PETIO VLADIMIROV KOTOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 COLCHESTER AVE, BURLINGTON, VT 05401-1473
(802) 847-0000
Mailing address
500 CAMPUS DR., HANCOCK, MI 49930-1569
(906) 048-3100
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
Primary
042-0015453
VT
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
4301087243
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0829560001
MEDICARE DME
MI
01
—
0C16002
MEDICARE GROUP
MI
05
—
4968078
—
MI
01
—
PK087243
BLUE CROSS STATE ID
MI
Enumeration date
05/25/2006
Last updated
08/25/2021
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