Individual
KEVIN G. KOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
12866 TROXLER AVE, HIGHLAND, IL 62249-2806
(618) 900-1070
(833) 992-2437
Mailing address
PO BOX 160, TROY, IL 62294-0160
(618) 900-1070
(833) 992-2437
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
02003992A
IN
207X00000X
Orthopaedic Surgery Physician
03476
KY
207X00000X
Orthopaedic Surgery Physician
Primary
036132543
IL
207XS0117X
Orthopaedic Surgery of the Spine Physician
03476
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000777934
ANTHEM
KY
05
—
036-132543
—
IL
05
—
201114320A
—
IN
05
—
7100213750
—
KY
Enumeration date
09/11/2007
Last updated
03/05/2026
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