Healthcare Provider Details

I. General information

NPI: 1578052940
Provider Name (Legal Business Name): PARTH A. KOTHARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 09/24/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 SR 64 E
BRADENTON FL
34212-7703
US

IV. Provider business mailing address

8000 SR 64 E
BRADENTON FL
34212-7703
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-1404
  • Fax: 941-761-0712
Mailing address:
  • Phone: 941-792-1404
  • Fax: 941-761-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME167737
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: