Provider Demographics
NPI:1245252733
Name:KOTTAPALLI, MAHESH B (MD)
Entity type:Individual
Prefix:DR
First Name:MAHESH
Middle Name:B
Last Name:KOTTAPALLI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2727 BOLTON BOONE DR
Mailing Address - Street 2:109
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2019
Mailing Address - Country:US
Mailing Address - Phone:972-283-2370
Mailing Address - Fax:972-296-0311
Practice Address - Street 1:2727 BOLTON BOONE DR
Practice Address - Street 2:109
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2019
Practice Address - Country:US
Practice Address - Phone:972-283-2370
Practice Address - Fax:972-296-0311
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2013-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM1846207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177764102Medicaid
TX177764101Medicaid
TXI44468Medicare UPIN
TX8J9797Medicare PIN
TX8G0951Medicare ID - Type Unspecified