Provider Demographics
NPI:1740282037
Name:KOTHARI, MILAN A (MD)
Entity type:Individual
Prefix:DR
First Name:MILAN
Middle Name:A
Last Name:KOTHARI
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 1:483 N SEMORAN BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3800
Mailing Address - Country:US
Mailing Address - Phone:407-645-1847
Mailing Address - Fax:321-274-0246
Practice Address - Street 1:483 N SEMORAN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3800
Practice Address - Country:US
Practice Address - Phone:407-645-1847
Practice Address - Fax:321-274-0246
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90535207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46083OtherBCBS OF FL PROV ID #
FL17688OtherFHHS PROV ID #
FL264936OtherAMERIGROUP MCD PROV ID #
FL271143500Medicaid
FL7088225OtherAETNA PROV ID
FL1459487OtherCIGNA PROV ID #
FL2088848OtherUNITED H'CARE PROV ID #
FL1953690OtherFIRST HEALTH PROV ID #
FLP00142714OtherRAILROAD MEDICARE
FL1106336OtherHUMANA PROV ID #
FL2088848OtherUNITED H'CARE PROV ID #
FLP00142714OtherRAILROAD MEDICARE