Provider Demographics
NPI:1164600235
Name:NADIPALLI, KOTESHWARA RAO (MD)
Entity Type:Individual
Prefix:
First Name:KOTESHWARA
Middle Name:RAO
Last Name:NADIPALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KOTESHWARA
Other - Middle Name:RAO
Other - Last Name:NANDIPALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2812 FOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3530
Mailing Address - Country:US
Mailing Address - Phone:469-955-6333
Mailing Address - Fax:972-688-6191
Practice Address - Street 1:3800 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2838
Practice Address - Country:US
Practice Address - Phone:972-666-4422
Practice Address - Fax:972-688-6191
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1007207P00000X, 207Q00000X, 207Q00000X, 207Q00000X
NY250769207Q00000X, 207Q00000X
GA061925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine