Provider Demographics
NPI:1023809282
Name:KOTHA, RUDRANI (MD)
Entity type:Individual
Prefix:MS
First Name:RUDRANI
Middle Name:
Last Name:KOTHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13995 W STATLER BLVD UNIT 200
Mailing Address - Street 2:
Mailing Address - City:SUPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:602-478-3100
Mailing Address - Fax:
Practice Address - Street 1:13995 W STATLER BLVD UNIT 200
Practice Address - Street 2:
Practice Address - City:SUPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:602-478-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program