MEDICARE: PETER KRISHNA KROTHAPALLI DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	DO.2975	AL

General Provider Information

NPI Number	:	1285193268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER KRISHNA KROTHAPALLI DO

Provider Business Mailing Address
First Line	:	4163 LOMAC ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-2881
Country	:	US
Telephone Number	:	334-819-4770
Fax Number	:	888-440-2618

Provider Business Practice Location Address
First Line	:	4163 LOMAC ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-2881
Country	:	US
Telephone Number	:	334-819-4770
Fax Number	:	888-440-2618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	11/22/2024

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