National Provider Identifier Database

JACK P KOTLARZ, MD – NPI #1922090646
Plastic Surgery within the Head & Neck

An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them.


Contact Information

JACK P KOTLARZ, MD
1253 N ALPINE RD
ROCKFORD, IL61107-2201
Phone: 779-696-9201
Fax: 815-397-9667
Website:
Specialty Taxonomy Code
* Plastic Surgery within the Head & Neck 207YX0007X
Otolaryngology 207Y00000X
Specialist 174400000X

* Indicates primary specialty

NPI Profile & details for JACK P KOTLARZ

NPI Number 1922090646
Credentials MD
Entity Individual
Enumeration date 08/18/2005
Last updated 12/10/2024 - More than a year ago
Sole proprietor1 Yes
Identifiers
  • FL License #: ME62757
  • IL License #: 036170362
  • MO License #: 2024013411
  • FL Medicaid: 253548300
  • AL Other: 590 51780 BCBS OF ALA
  • AL Other: 009900475 MEDICAID ALA
  • FL Other: 4314144 AETNA
  • FL Other: 42544 BCBS OF FLORIDA
  • FL Other: 7618346003 CIGNA PPO
  • FL Other: 040016528 UHC MCR RR
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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