Individual
DR. AZHAR KOTHAWALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1235 N MULFORD RD STE 222, ROCKFORD, IL 61107-3879
(815) 397-8400
(815) 229-0050
Mailing address
2202 HARLEM ROAD, SUITE 200, LOVES PARK, IL 61111-2754
(815) 877-4848
(815) 636-6125
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036.140452
IL
207LP2900X
Pain Medicine (Anesthesiology) Physician
036.140452
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036140452
—
IL
Enumeration date
08/12/2012
Last updated
12/06/2024
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