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General NPI Number Information
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NPI Number | 1558386607
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Entity Type | Individual
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Provider Name | TERRI LYNN BOTT-KOTHARI MD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 11/19/2011
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Provider Practice Location Address
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Address Line | 5950 METRO WAY SW
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City | WYOMING
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State | MI
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Zip | 49519-9514
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Country | US
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Telephone | 616-252-8160
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Fax |
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Provider Business Mailing Address
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Address Line | 3621 S STATE ST 700 KMS PLACE
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City | ANN ARBOR
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State | MI
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Zip | 48108
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Country | US
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Telephone | 734-936-2047
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Fax |
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 077359
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 4301077359
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License Number State | MI
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