Provider Demographics
NPI:1467440404
Name:KOTIPOYINA, RAJU (MD)
Entity Type:Individual
Prefix:
First Name:RAJU
Middle Name:
Last Name:KOTIPOYINA
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 1:1290 GOLFVIEW AVE
Mailing Address - Street 2:4TH FLOOR ATTN: BILLING DEPARTMENT
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-6738
Mailing Address - Country:US
Mailing Address - Phone:863-519-7900
Mailing Address - Fax:863-519-7696
Practice Address - Street 1:3241 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2266
Practice Address - Country:US
Practice Address - Phone:863-413-2620
Practice Address - Fax:863-499-2612
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44182207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042509500Medicaid
FL51244ZMedicare PIN
FL042509500Medicaid