Provider Demographics
NPI:1740723527
Name:SUMANKRISHNA KOTLA MD
Entity type:Organization
Organization Name:SUMANKRISHNA KOTLA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUMANKRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-248-8894
Mailing Address - Street 1:1505 LBJ FWY STE 700
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6065
Mailing Address - Country:US
Mailing Address - Phone:214-358-2300
Mailing Address - Fax:214-579-6941
Practice Address - Street 1:411 N WASHINGTON AVE STE 6000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1789
Practice Address - Country:US
Practice Address - Phone:214-358-2300
Practice Address - Fax:214-579-6988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RN0300X, 207RN0300X
PAMD443138208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR1400OtherMEDICAL LICENSE