Provider Demographics
NPI:1013185107
Name:KOTHARI, SAMIP DHIREN (MD)
Entity Type:Individual
Prefix:
First Name:SAMIP
Middle Name:DHIREN
Last Name:KOTHARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 N WATER ST APT 403
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1588
Mailing Address - Country:US
Mailing Address - Phone:608-347-1776
Mailing Address - Fax:
Practice Address - Street 1:1925 N WATER ST APT 403
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-1588
Practice Address - Country:US
Practice Address - Phone:608-347-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ81151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics