Provider Demographics
NPI:1922148113
Name:KOTHAPALLI & KOTHAPALLI LTD, APMC
Entity Type:Organization
Organization Name:KOTHAPALLI & KOTHAPALLI LTD, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANKARAIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTHAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:337-266-5592
Mailing Address - Street 1:134 HOSPITAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2819
Mailing Address - Country:US
Mailing Address - Phone:337-266-5592
Mailing Address - Fax:337-266-5594
Practice Address - Street 1:134 HOSPITAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2819
Practice Address - Country:US
Practice Address - Phone:337-266-5592
Practice Address - Fax:337-266-5594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10035R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty