Healthcare Provider Details

I. General information

NPI: 1053351957
Provider Name (Legal Business Name): SUNIL KOTHARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 MOURSUND ST
HOUSTON TX
77030-3405
US

IV. Provider business mailing address

PO BOX 200903
HOUSTON TX
77216-0903
US

V. Phone/Fax

Practice location:
  • Phone: 713-797-5238
  • Fax: 713-797-5241
Mailing address:
  • Phone: 281-252-9993
  • Fax: 281-252-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberK1228
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: