MEDICARE: DR. RAVI KOTHURU M.D.

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	223921	NY

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

General Provider Information

NPI Number	:	1649227794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAVI KOTHURU M.D.

Provider Business Mailing Address
First Line	:	9413 FLATLANDS AVE
Second Line	:	SUITE 002 EAST
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3726
Country	:	US
Telephone Number	:	718-257-7770
Fax Number	:	718-257-7550

Provider Business Practice Location Address
First Line	:	9413 FLATLANDS AVE
Second Line	:	SUITE 002 EAST
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3726
Country	:	US
Telephone Number	:	718-257-7770
Fax Number	:	718-257-7550

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	10/16/2013

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