Individual
KETAN HASHMUKH KOTHARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1546 PRATT STREET, PHILADELPHIA, PA 19124-1923
(215) 533-8555
(215) 533-8656
Mailing address
1546 PRATT STREET, PHILADELPHIA, PA 19124-1923
(215) 533-8555
(215) 533-8656
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
SC004645L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018311680001
—
PA
01
—
246839
FIRST HEALTH
PA
01
—
30004716
KEYSTONE MERCY
PA
01
—
3075350
AETNA
PA
01
—
480032950
RAIL ROAD MEDICARE
—
01
—
K0830767
BLUE SHIELD
PA
01
—
U81914
UNITED
—
01
—
U8914
HEALTH PARTNERS
—
Enumeration date
12/13/2006
Last updated
07/04/2010
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