Individual
AMY D KOTANSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RD, CDCES, LD
Contact information
Practice address
5230 E STOP 11 RD STE 150, INDIANAPOLIS, IN 46237-6399
(317) 865-5904
(317) 865-5321
Mailing address
PO BOX 781076, DETROIT, MI 48278-3629
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37000390A
IN
133V00000X
Registered Dietitian
711259
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37000390A
LICENSE
IN
Enumeration date
08/10/2006
Last updated
08/18/2023
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