Provider Demographics
NPI:1568852838
Name:KOTTARATHARA, ARUN JOSE (MD)
Entity Type:Individual
Prefix:
First Name:ARUN
Middle Name:JOSE
Last Name:KOTTARATHARA
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 1:2006 LIMESTONE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5553
Mailing Address - Country:US
Mailing Address - Phone:302-355-2383
Mailing Address - Fax:
Practice Address - Street 1:2006 LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5553
Practice Address - Country:US
Practice Address - Phone:302-355-2383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-26
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61151370207RN0300X
WI1676-320207RN0300X
MI4301113282207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100193040Medicaid