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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 Specialty Code Provider Type

Plastic Surgery within the Head & Neck

207YX0007X 04 Physician/Otolaryngology
 

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
 

Specialist

174400000X
Indicates primary specialty

NPI Profile & details for JACK P KOTLARZ · (Male)

NPI # 1922090646
Status Active
Credentials MD
Entity Individual
Enumeration date 08/18/2005
Last updated 12/10/2024 - More than a year ago
Sole proprietor 1 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(s)
  • BAPTIST HOSPITAL - (Acute Care)
    1000 W MORENO ST
    PENSACOLA, FL 32501
  • SACRED HEART HOSPITAL - (Acute Care)
    5151 N 9TH AVE
    PENSACOLA, FL 32504
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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