Healthcare Provider Details

I. General information

NPI: 1114934833
Provider Name (Legal Business Name): USHA D KOTHARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7040 LAWNDALE ST STE B
HOUSTON TX
77023
US

IV. Provider business mailing address

PO BOX 230138
HOUSTON TX
77223-0138
US

V. Phone/Fax

Practice location:
  • Phone: 713-921-9211
  • Fax: 713-921-7955
Mailing address:
  • Phone: 713-921-9211
  • Fax: 713-921-7955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF5611
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: