Provider Demographics
NPI:1316972672
Name:KOTSCHWAR, DELORES E (MD)
Entity type:Individual
Prefix:DR
First Name:DELORES
Middle Name:E
Last Name:KOTSCHWAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3400 LAFAYETTE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1146
Mailing Address - Country:US
Mailing Address - Phone:317-291-7422
Mailing Address - Fax:317-291-7433
Practice Address - Street 1:3400 LAFAYETTE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1146
Practice Address - Country:US
Practice Address - Phone:317-291-7422
Practice Address - Fax:317-291-7433
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048809A207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200190140Medicaid
IN200190140Medicaid