Healthcare Provider Details

I. General information

NPI: 1558898197
Provider Name (Legal Business Name): NEETI KOTHARE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2017
Last Update Date: 04/13/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 FANNIN STREET MAIN 556
HOUSTON TX
77030
US

IV. Provider business mailing address

6565 FANNIN STREET MAIN 556
HOUSTON TX
77030
US

V. Phone/Fax

Practice location:
  • Phone: 412-441-0428
  • Fax: 713-441-0444
Mailing address:
  • Phone: 713-441-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberT3319
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: