Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4302089244 | MI |
N | 111NI0900X | Internist | 4302089244 | MI |
N | 207R00000X | Internist | MD00044508 | WA |
N | 111NI0900X | Internist | MD00044508 | WA |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | C55542 | CA |
NPI | 1093799959 |
---|---|
Provider Name | Dr. Michael Roy Koteles JR. |
First Address | Travis Afb, CA 94535-1809 |
Second Address | Travis Afb, CA 94535-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 26/04/2013 |