Healthcare Provider Details

I. General information

NPI: 1336594191
Provider Name (Legal Business Name): SUJIT KUMAR KOTAPATI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SUJIT KUMAR KOTAPATI MD

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6929 JOHN F KENNEDY BLVD STE 104
NORTH LITTLE ROCK AR
72116-5358
US

IV. Provider business mailing address

6929 JOHN F KENNEDY BLVD STE 104
NORTH LITTLE ROCK AR
72116-5358
US

V. Phone/Fax

Practice location:
  • Phone: 501-235-8295
  • Fax: 501-471-0771
Mailing address:
  • Phone: 501-235-8295
  • Fax: 501-471-0771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-14472
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: