Healthcare Provider Details

I. General information

NPI: 1245252733
Provider Name (Legal Business Name): MAHESH B KOTTAPALLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 BOLTON BOONE DR 109
DESOTO TX
75115-2019
US

IV. Provider business mailing address

2727 BOLTON BOONE DR 109
DESOTO TX
75115-2019
US

V. Phone/Fax

Practice location:
  • Phone: 972-283-2370
  • Fax: 972-296-0311
Mailing address:
  • Phone: 972-283-2370
  • Fax: 972-296-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberM1846
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: