Basic Information
| Provider Information | |||||||||
| NPI: | 1467726034 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KOTTER FOOT & ANKLE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1249 | ||||||||
| Address2: | |||||||||
| City: | BOUNTIFUL | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840111249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012962113 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5320 S 1950 W | ||||||||
| Address2: | |||||||||
| City: | ROY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840672423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012962113 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/29/2012 | ||||||||
| LastUpdateDate: | 02/29/2012 | ||||||||
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| AuthorizedOfficialLastName: | KOTTER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8012962113 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 344339-0501 | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.