Kothawala, Azhar

Kothawala, Azhar is an individual health care provider with primary practice located at 1235 N Mulford Rd Ste 222 , Rockford IL 61107-3879. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Anesthesiology. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Kothawala, Azhar can be contacted via phone (815) 397-8400.

Contact Information

Primary practice address
1235 N Mulford Rd Ste 222 Rockford IL 61107-3879
Phone: (815) 397-8400
Fax: (815) 229-0050
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X 036.140452 Illinois
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 036.140452 Illinois

Profile Details

NPI number 1891042552
LBN Legal business name Kothawala, Azhar
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 12th, 2012
Last updated Jul 30th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891042552 NPPES
Illinois MEDICAID 036140452

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