Healthcare Provider Details

I. General information

NPI: 1467404988
Provider Name (Legal Business Name): AJEET KOTHARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20800 WESTGATE MALL #206
CLEVELAND OH
44126-1323
US

IV. Provider business mailing address

20800 WESTGATE MALL #206
CLEVELAND OH
44126-1323
US

V. Phone/Fax

Practice location:
  • Phone: 440-331-4666
  • Fax:
Mailing address:
  • Phone: 440-331-4666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35-047000
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: