Healthcare Provider Details

I. General information

NPI: 1821055328
Provider Name (Legal Business Name): PAULSON KOTTURAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SW NATURA AVE
DEERFIELD BEACH FL
33441-3026
US

IV. Provider business mailing address

220 SW NATURA AVE
DEERFIELD BEACH FL
33441-3026
US

V. Phone/Fax

Practice location:
  • Phone: 954-360-7000
  • Fax: 954-360-7511
Mailing address:
  • Phone: 954-360-7000
  • Fax: 954-360-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0050768
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: