Provider Demographics
NPI:1396278479
Name:KOTTAPALLI, SAI MANOJ
Entity type:Individual
Prefix:
First Name:SAI
Middle Name:MANOJ
Last Name:KOTTAPALLI
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 1:8930 W SUNSET RD UNIT 250
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5008
Mailing Address - Country:US
Mailing Address - Phone:702-565-8346
Mailing Address - Fax:702-202-2000
Practice Address - Street 1:8930 W SUNSET RD UNIT 250
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5008
Practice Address - Country:US
Practice Address - Phone:702-565-8346
Practice Address - Fax:702-202-2000
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NVDO30632086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1396278479Medicaid