MEDICARE: PURNIMA A KOTHARI MD

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	207V00000X	Obstetrics & Gynecology Physician	35-044273	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000380518	OTHER		ANTHEM

General Provider Information

NPI Number	:	1508973744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PURNIMA A KOTHARI MD

Provider Business Mailing Address
First Line	:	20800 WESTGATE MALL
Second Line	:	#206
City	:	CLEVELAND
State	:	OH
Zip	:	44126-1323
Country	:	US
Telephone Number	:	440-331-4666
Fax Number	:

Provider Business Practice Location Address
First Line	:	20800 WESTGATE MALL
Second Line	:	#206
City	:	CLEVELAND
State	:	OH
Zip	:	44126-1323
Country	:	US
Telephone Number	:	440-331-4666
Fax Number	:

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	12/16/2011

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