Provider Demographics
NPI:1477650703
Name:KOTECHA, KRISHNAKUMAR M (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNAKUMAR
Middle Name:M
Last Name:KOTECHA
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 1:4304 SEQUOIA ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-4630
Mailing Address - Country:US
Mailing Address - Phone:620-662-4093
Mailing Address - Fax:
Practice Address - Street 1:750 W D AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068
Practice Address - Country:US
Practice Address - Phone:620-532-3147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-175982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D17339Medicare UPIN
059918Medicare ID - Type Unspecified