Healthcare Provider Details

I. General information

NPI: 1386045391
Provider Name (Legal Business Name): KOTESHWARA NADIPALLI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 MAIN ST STE 100
THE COLONY TX
75056-2838
US

IV. Provider business mailing address

3800 MAIN ST STE 100
THE COLONY TX
75056-2838
US

V. Phone/Fax

Practice location:
  • Phone: 972-666-4422
  • Fax:
Mailing address:
  • Phone: 972-666-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KOTESHWARA RAO NADIPALLI
Title or Position: PHYSICIAN
Credential:
Phone: 469-955-6333