=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053351957
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUNIL KOTHARI M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2006
-----------------------------------------------------
Last Update Date | 11/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1333 MOURSUND ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-3405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-797-5238
-----------------------------------------------------
Fax | 713-797-5241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 200903
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77216-0903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-252-9993
-----------------------------------------------------
Fax | 281-252-9997
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | K1228
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------