Individual
PRAVEENA R KOTHUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6003 W THUNDERBIRD RD STE 1, GLENDALE, AZ 85306-4004
(602) 805-3129
(888) 355-6609
Mailing address
PO BOX 5148, GLENDALE, AZ 85312-5148
(602) 805-3129
(888) 355-6609
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
30666
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
792053
—
AZ
Enumeration date
05/25/2006
Last updated
07/25/2025
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