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Individual
SURESH K KOTA
Active
Individual
SURESH K KOTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35611
IA
207R00000X
Internal Medicine Physician
47025
WI
207R00000X
Internal Medicine Physician
Primary
M8095
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0749283
—
IA
05
—
1749283
—
IA
05
—
34539400
—
WI
01
—
47568
WELLMARK BLUE CROSS
IA
01
—
M8095
TX LIC
TX
Enumeration date
01/25/2007
Last updated
09/12/2023
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