Kota Medical PC
Internal Medicine, Gastroenterology in Portage, IN. Organization (NPI-2).
NPI number1063668614
StatusActive
Last updated in NPPESMar 28, 2013
Details
- NPI
- 1063668614
- Entity type
- Organization (NPI-2)
- Legal business name
- Kota Medical PC
- Organization subpart
- No
- Enumeration date
- Aug 14, 2008
- Last updated
- Mar 28, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RG0100X | Internal Medicine, Gastroenterology | 01038987 | IN | Yes |
| 207R00000X | Internal Medicine | 01038987 | IN |
Practice location
3630 Willowcreek RdPortage, IN 46368-5075
Phone 219-759-5812 · Fax 219-759-5890
Mailing address
3630 Willowcreek RdPortage, IN 46368-5075
Phone 219-759-5812 · Fax 219-759-5890
Authorized official
Ranga Rao Kota
Owner
2197595812
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