Provider Demographics
NPI:1194130948
Name:KOTTWITZ, KATHERINE MCKENNA (MD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MCKENNA
Last Name:KOTTWITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:ELEANOR
Other - Last Name:MCKENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:111 S GREEN RIVER RD STE F
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7338
Mailing Address - Country:US
Mailing Address - Phone:217-414-6057
Mailing Address - Fax:
Practice Address - Street 1:111 S GREEN RIVER RD STE F
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7338
Practice Address - Country:US
Practice Address - Phone:812-436-1203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY538472086S0122X
IN01086007208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery