Individual
MR. EDUARD VOLFOVITCH KOTLYAROV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1375 N MAIN ST, LAPEER, MI 48446-1350
(810) 667-5500
Mailing address
PO BOX 32627, DETROIT, MI 48232-0627
(866) 744-1452
(586) 412-4101
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
0101032700
VA
2085N0904X
Nuclear Radiology Physician
4301061744
MI
2085N0904X
Nuclear Radiology Physician
D0026059
MD
2085N0904X
Nuclear Radiology Physician
MD11451
DC
2085R0202X
Diagnostic Radiology Physician
0101032700
VA
2085R0202X
Diagnostic Radiology Physician
Primary
4301061744
MI
2085R0202X
Diagnostic Radiology Physician
D0026059
MD
2085R0202X
Diagnostic Radiology Physician
MD11451
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2965193
—
MI
05
—
2965228
—
MI
01
—
300049506
RRMC
MI
01
—
3006399421
BCBS PIN #
MI
01
—
310D460020
BCBS GROUP PIN
MI
01
—
CA5318
MEDICARE RR GROUP PIN
MI
Enumeration date
05/30/2006
Last updated
02/06/2013
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