Healthcare Provider Details

I. General information

NPI: 1184114415
Provider Name (Legal Business Name): ANEESH ANJAN KOTHARE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST STE 350
HOUSTON TX
77030-3004
US

IV. Provider business mailing address

6410 FANNIN ST STE 350
HOUSTON TX
77030-3004
US

V. Phone/Fax

Practice location:
  • Phone: 832-325-7200
  • Fax: 713-512-2237
Mailing address:
  • Phone: 832-325-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberT8580
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: