Provider Demographics
NPI:1174776165
Name:SUNIL KUMAR KOTTUR LLC
Entity type:Organization
Organization Name:SUNIL KUMAR KOTTUR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:KOTTUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-672-5663
Mailing Address - Street 1:2301 OHIO DRIVE
Mailing Address - Street 2:SUITE 295
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3998
Mailing Address - Country:US
Mailing Address - Phone:972-672-5663
Mailing Address - Fax:972-596-5284
Practice Address - Street 1:2301 OHIO DRIVE
Practice Address - Street 2:SUITE 295
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3998
Practice Address - Country:US
Practice Address - Phone:972-672-5663
Practice Address - Fax:972-596-5284
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNIL KUMAR KOTTUR, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-04
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK51362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8G1614Medicare PIN
TXG85826Medicare UPIN