Healthcare Provider Details

I. General information

NPI: 1710154927
Provider Name (Legal Business Name): VEERA PAVAN KUMAR KOTARU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE 725
LANSING MI
48912-1800
US

IV. Provider business mailing address

1200 E MICHIGAN AVE 725
LANSING MI
48912-1800
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5599
  • Fax: 517-364-5590
Mailing address:
  • Phone: 517-364-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301085630
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301085630
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: