Provider Demographics
NPI:1245082726
Name:KOTTARATHIL, VARGHESE DANIEL
Entity type:Individual
Prefix:MR
First Name:VARGHESE
Middle Name:DANIEL
Last Name:KOTTARATHIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14085 350TH ST
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045-9059
Mailing Address - Country:US
Mailing Address - Phone:612-999-4320
Mailing Address - Fax:
Practice Address - Street 1:14085 350TH ST
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045-9059
Practice Address - Country:US
Practice Address - Phone:612-999-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency