Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jack Peter Kotlarz, MD

Individual provider Specialist · NPI 1922090646

Jack Peter Kotlarz, MD is an Otolaryngology in Rockford, Illinois. Graduated from University of Illinois College of Med (CHI/PEOR/ROCK/Chm-Urb) in 1987, 39 years ago. Practices with Ocala Health Surgical Group LLC, a 51-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Florida, Illinois and Missouri.

Years since qualifying
39
Trained at
University of Illinois College of Med (CHI/PEOR/ROCK/Chm-Urb)
Licensed in
FL, IL, MO
In the registry since
2005
Specialties on file
4
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1253 N Alpine Rd
Rockford, IL 61107-2201
Phone: (779) 696-9201
Fax: (815) 397-9667
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 6100 North Davis Hwy, Pensacola, FL 32504-6950 — (850) 471-2377
  • 3100 E Fletcher Ave, Tampa, FL 33613-4613 — (813) 971-6000

Specialties & licences

Plastic Surgery within the Head & Neck (Otolaryngology) Physician (primary) Taxonomy 207YX0007X · Licence 036170362 (IL)
Specialist Taxonomy 174400000X · Licence ME62757 (FL)
Otolaryngology Physician Taxonomy 207Y00000X · Licence ME62757 (FL)
Otolaryngology Physician Taxonomy 207Y00000X · Licence 2024013411 (MO)

Record details

NPI number1922090646
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedAugust 18, 2005
Last updated in NPPESDecember 10, 2024
Certification dateDecember 10, 2024
Mailing address6100 North Davis Hwy, Pensacola, FL 32504-6950

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOTOLARYNGOLOGY
Also practisesPLASTIC AND RECONSTRUCTIVE SURGERY
Medical schoolUNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduated 1987 (39 years in practice)
Group practice Ocala Health Surgical Group Llc — 51 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Rockford