Provider Demographics
NPI:1932209764
Name:KOTARU, CHAKRADHAR (MD)
Entity Type:Individual
Prefix:
First Name:CHAKRADHAR
Middle Name:
Last Name:KOTARU
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 1:5200 DTC PARKWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2719
Mailing Address - Country:US
Mailing Address - Phone:303-745-0000
Mailing Address - Fax:303-773-3675
Practice Address - Street 1:5200 DTC PARKWAY
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2719
Practice Address - Country:US
Practice Address - Phone:303-745-0000
Practice Address - Fax:303-773-3675
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40847207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51305089Medicaid
COC805331Medicare PIN
COH15360Medicare UPIN