Organization
VIJAYA GOPAL KOTHA MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIJAYA GOPAL KOTHA MD (OWNER)
(313) 595-7336
Entity
Organization
Contact information
Practice address
22101 MOROSS RD FL 6, DETROIT, MI 48236-2148
(313) 343-7560
Mailing address
591 LAKE SHORE RD, GROSSE POINTE SHORES, MI 48236-2631
(313) 595-7336
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301058577
LICENSE NUMBER
MI
Enumeration date
05/31/2018
Last updated
05/31/2018
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