Healthcare Provider Details

I. General information

NPI: 1922530500
Provider Name (Legal Business Name): PIANKHI OTHELOT M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2017
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3269 N STOCKTON HILL RD
KINGMAN AZ
86409-3619
US

IV. Provider business mailing address

310 W 99TH ST APT 801
NEW YORK NY
10025-5422
US

V. Phone/Fax

Practice location:
  • Phone: 928-681-8577
  • Fax:
Mailing address:
  • Phone: 646-399-3213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberC1-0026413
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30643801
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: