Provider Demographics
NPI:1346251139
Name:KOTTUR, SUNIL KUMAR (MD)
Entity Type:Individual
Prefix:MR
First Name:SUNIL
Middle Name:KUMAR
Last Name:KOTTUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KOTTURAPPA
Other - Middle Name:SUNIL
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2301 OHIO DRIVE
Mailing Address - Street 2:SUITE 295
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3998
Mailing Address - Country:US
Mailing Address - Phone:972-672-5663
Mailing Address - Fax:972-596-5284
Practice Address - Street 1:2301 OHIO DRIVE
Practice Address - Street 2:SUITE 295
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3998
Practice Address - Country:US
Practice Address - Phone:972-672-5663
Practice Address - Fax:972-596-5284
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK51362084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G1614Medicare PIN
TX8L3052Medicare PIN
TXG85826Medicare UPIN