Provider Demographics
NPI:1427448406
Name:KOTILA SPINE & JOINT CENTER OF BRANDON LLC
Entity type:Organization
Organization Name:KOTILA SPINE & JOINT CENTER OF BRANDON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOTILA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-643-1242
Mailing Address - Street 1:1451 OAKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4854
Mailing Address - Country:US
Mailing Address - Phone:813-643-1242
Mailing Address - Fax:813-643-1246
Practice Address - Street 1:1451 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4854
Practice Address - Country:US
Practice Address - Phone:813-643-1242
Practice Address - Fax:813-643-1246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty