Provider Demographics
NPI:1922113075
Name:KOTHUR, RAMKRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMKRISHNA
Middle Name:
Last Name:KOTHUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3020 E CAMELBACK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5095
Mailing Address - Country:US
Mailing Address - Phone:602-264-9100
Mailing Address - Fax:602-264-9101
Practice Address - Street 1:13640 N 99TH AVE STE 600
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-2867
Practice Address - Country:US
Practice Address - Phone:623-972-2116
Practice Address - Fax:623-972-0521
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ30654207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE59343Medicare UPIN