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General NPI Number Information
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NPI Number | 1114973179
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Entity Type | Individual
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Provider Name | PRAVEENA R KOTHUR M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 6003 W THUNDERBIRD RD STE 1
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City | GLENDALE
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State | AZ
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Zip | 85306-4004
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Country | US
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Telephone | 602-805-3129
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Fax | 888-355-6609
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Provider Business Mailing Address
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Address Line | PO BOX 5148
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City | GLENDALE
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State | AZ
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Zip | 85312-5148
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Country | US
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Telephone | 602-805-3129
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Fax | 888-355-6609
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 30666
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License Number State | AZ
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