Healthcare Provider Details

I. General information

NPI: 1770721912
Provider Name (Legal Business Name): RAJESH KOTAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 EICHENFELD DR STE 106
BRANDON FL
33511-5997
US

IV. Provider business mailing address

3820 NORTHDALE BLVD STE 201 STE 201,
TAMPA FL
33624-1893
US

V. Phone/Fax

Practice location:
  • Phone: 800-991-6117
  • Fax: 888-812-8191
Mailing address:
  • Phone: 800-991-6117
  • Fax: 888-812-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberME113098
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME113098
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: