1174776165 NPI number — SUNIL KUMAR KOTTUR LLC

Table of content: (NPI 1174776165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174776165 NPI number — SUNIL KUMAR KOTTUR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNIL KUMAR KOTTUR LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SUNIL KOTTUR, MD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174776165
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 OHIO DRIVE
Provider Second Line Business Mailing Address:
SUITE 295
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093-3998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-672-5663
Provider Business Mailing Address Fax Number:
972-596-5284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 OHIO DRIVE
Provider Second Line Business Practice Location Address:
SUITE 295
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-3998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-672-5663
Provider Business Practice Location Address Fax Number:
972-596-5284
Provider Enumeration Date:
11/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KOTTUR
Authorized Official First Name:
SUNIL
Authorized Official Middle Name:
KUMAR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-672-5663

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  K5136 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)