Provider Demographics
NPI:1023265436
Name:MAHESH KOTTAPALLI, MD PA
Entity type:Organization
Organization Name:MAHESH KOTTAPALLI, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-216-9511
Mailing Address - Street 1:PO BOX 851376
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-1376
Mailing Address - Country:US
Mailing Address - Phone:972-216-9511
Mailing Address - Fax:972-216-9580
Practice Address - Street 1:208 W KEARNEY ST
Practice Address - Street 2:107
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-3476
Practice Address - Country:US
Practice Address - Phone:972-216-9511
Practice Address - Fax:972-216-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1846207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I44468Medicare UPIN