Organization
KOTA MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANGA RAO KOTA MD (OWNER)
(219) 759-5812
Entity
Organization
Contact information
Practice address
3630 WILLOWCREEK RD, PORTAGE, IN 46368-5075
(219) 759-5812
(219) 759-5890
Mailing address
3630 WILLOWCREEK RD, PORTAGE, IN 46368-5075
(219) 759-5812
(219) 759-5890
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01038987
IN
207RG0100X
Gastroenterology Physician
Primary
01038987
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200007810
—
IN
Enumeration date
08/14/2008
Last updated
03/28/2013
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