Provider Demographics
NPI:1093789968
Name:CLINIC FOR DIGESTIVE DISEASES, PC
Entity Type:Organization
Organization Name:CLINIC FOR DIGESTIVE DISEASES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMKRISHNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-972-2116
Mailing Address - Street 1:13203 N 103RD AVE
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-3099
Mailing Address - Country:US
Mailing Address - Phone:623-972-2116
Mailing Address - Fax:623-972-0521
Practice Address - Street 1:13203 N 103RD AVE
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3099
Practice Address - Country:US
Practice Address - Phone:623-972-2116
Practice Address - Fax:623-972-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0805210OtherBCBS OF AZ/DR BETTINGER
AZ99S007600002OtherSUN HLTH/DR BELLAPRAVALU
AZ788036Medicaid
AZ250944-02Medicaid
AZ268830-02Medicaid
AZAZ0360800OtherBCBS/DR PHELPS
AZAZ0727350OtherBCBS/DR KOTHUR
AZAZ0750990OtherBCBS DR CHOKSHI
AZ002410-02Medicaid
AZAZ0187530OtherBCBS/DR PATEL
AZ208604-02Medicaid
AZ855918Medicaid
AZAZ0361810OtherBCBS/DR BELLAPRAVAL
AZ250944-02Medicaid
AZ002410-02Medicaid
AZ855918Medicaid
AZD37448Medicare UPIN
AZD37421Medicare UPIN
AZC99117Medicare UPIN
AZ208604-02Medicaid