Provider Demographics
NPI:1215267596
Name:KOTWAL, VIKRAM S (MD)
Entity type:Individual
Prefix:
First Name:VIKRAM
Middle Name:S
Last Name:KOTWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1750 E LAKE SHORE DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3803
Mailing Address - Country:US
Mailing Address - Phone:217-464-1220
Mailing Address - Fax:217-464-1229
Practice Address - Street 1:1750 E LAKE SHORE DR
Practice Address - Street 2:SUITE 310
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3803
Practice Address - Country:US
Practice Address - Phone:217-464-1220
Practice Address - Fax:217-464-1229
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125.052336207R00000X
IL036-126060207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine