Healthcare Provider Details

I. General information

NPI: 1740282037
Provider Name (Legal Business Name): MILAN A KOTHARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 N SEMORAN BLVD SUITE 102
WINTER PARK FL
32792-3800
US

IV. Provider business mailing address

483 N SEMORAN BLVD SUITE 102
WINTER PARK FL
32792-3800
US

V. Phone/Fax

Practice location:
  • Phone: 407-645-1847
  • Fax: 321-274-0246
Mailing address:
  • Phone: 407-645-1847
  • Fax: 321-274-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME90535
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME90535
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberME90535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: