Healthcare Provider Details

I. General information

NPI: 1922148113
Provider Name (Legal Business Name): KOTHAPALLI & KOTHAPALLI LTD, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 HOSPITAL DR SUITE A
LAFAYETTE LA
70503-2819
US

IV. Provider business mailing address

134 HOSPITAL DR SUITE A
LAFAYETTE LA
70503-2819
US

V. Phone/Fax

Practice location:
  • Phone: 337-266-5592
  • Fax: 337-266-5594
Mailing address:
  • Phone: 337-266-5592
  • Fax: 337-266-5594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10035R
License Number StateLA

VIII. Authorized Official

Name: DR. SHANKARAIAH KOTHAPALLI
Title or Position: PHYSICIAN
Credential: M.D.,
Phone: 337-266-5592