Healthcare Provider Details

I. General information

NPI: 1548899636
Provider Name (Legal Business Name): MONICA KOTHARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 KANIS RD STE 1
LITTLE ROCK AR
72205-6205
US

IV. Provider business mailing address

10301 KANIS RD STE 1
LITTLE ROCK AR
72205-6205
US

V. Phone/Fax

Practice location:
  • Phone: 501-562-4838
  • Fax: 501-562-1958
Mailing address:
  • Phone: 501-562-4838
  • Fax: 501-562-1958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-16851
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: