Healthcare Provider Details

I. General information

NPI: 1154567022
Provider Name (Legal Business Name): PANAYOTA KOTSALI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2008
Last Update Date: 12/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 S 3RD ST
DANVILLE KY
40422-1823
US

IV. Provider business mailing address

412 HAWTHORNE DR
NICHOLASVILLE KY
40356-9509
US

V. Phone/Fax

Practice location:
  • Phone: 859-239-2448
  • Fax:
Mailing address:
  • Phone: 859-887-0557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number41063
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: