Healthcare Provider Details

I. General information

NPI: 1043653751
Provider Name (Legal Business Name): ANUPAMA KOTHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 WORNALL RD
KANSAS CITY MO
64111-3220
US

IV. Provider business mailing address

4401 WORNALL RD
KANSAS CITY MO
64111-3220
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-3584
  • Fax: 816-932-5873
Mailing address:
  • Phone: 816-932-3584
  • Fax: 816-932-5873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2021037387
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: