Provider Demographics
NPI:1922035252
Name:KOTAS, LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:KOTAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4461 COIT RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0521
Mailing Address - Country:US
Mailing Address - Phone:972-731-9299
Mailing Address - Fax:972-731-9909
Practice Address - Street 1:4461 COIT RD
Practice Address - Street 2:SUITE 205
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0521
Practice Address - Country:US
Practice Address - Phone:972-731-9299
Practice Address - Fax:972-731-9909
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7457207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R2080OtherBCBS INDIVIDUAL
TX1729196Medicaid
TX7845563OtherAETNA INDIVIDUAL
TX1729196Medicaid
TX8C9513Medicare ID - Type Unspecified