Individual
MR. LARRY J KOTEWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
124 W WHITEHALL CT, PEORIA, IL 61614-3032
(309) 691-2607
(309) 683-1003
Mailing address
124 W WHITEHALL CT, PEORIA, IL 61614-3032
(309) 691-2607
(309) 683-1003
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
—
IL
Other
Enumeration date
03/14/2006
Last updated
07/08/2007
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