Provider Demographics
NPI:1245523141
Name:POTHULOORI, AVIN (MD)
Entity type:Individual
Prefix:
First Name:AVIN
Middle Name:
Last Name:POTHULOORI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 CLAY EDWARDS DR STE 1250
Mailing Address - Street 2:C/O HELLMAN & ROSEN ENDOCRINE
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3260
Mailing Address - Country:US
Mailing Address - Phone:816-421-3700
Mailing Address - Fax:816-421-1654
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 1250
Practice Address - Street 2:C/O HELLMAN & ROSEN ENDOCRINE
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3260
Practice Address - Country:US
Practice Address - Phone:816-421-3700
Practice Address - Fax:816-421-1654
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2016030319207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01775520OtherRAILROAD MEDICARE
P01775520Medicare PIN
P01775520OtherRAILROAD MEDICARE