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Jack Peter Kotlarz, MD

Otolaryngology, Plastic Surgery within the Head & Neck in Rockford, IL. Individual provider (NPI-1).

NPI number1922090646
StatusActive
Last updated in NPPESDec 10, 2024

Details

NPI
1922090646
Entity type
Individual (NPI-1)
Name
Jack Peter Kotlarz
Credential
MD
Sex
Male
Sole proprietor
Yes
Enumeration date
Aug 18, 2005
Certification date
Dec 10, 2024
Last updated
Dec 10, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck036170362ILYes
174400000X SpecialistME62757FL
207Y00000X OtolaryngologyME62757FL
207Y00000X Otolaryngology2024013411MO

Practice location

1253 N Alpine Rd
Rockford, IL 61107-2201

Phone 779-696-9201 · Fax 815-397-9667

Mailing address

6100 North Davis Hwy
Pensacola, FL 32504-6950

Phone 850-471-2377 · Fax 850-471-9975

Other practice locations

6100 North Davis Hwy
Pensacola, FL 32504-6950

Phone 850-471-2377 · Fax 850-471-9975

3100 E Fletcher Ave
Tampa, FL 33613-4613

Phone 813-971-6000 · Fax 813-615-7542

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