Individual
SOONA KOTHAWALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1101 W UNIVERSITY DR, ROCHESTER, MI 48307-1863
(248) 601-6176
Mailing address
907 WYANDOTTE AVE, ROYAL OAK, MI 48067-4517
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704214560
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
BLUE CROSS BLUE SHEILD
MI
Enumeration date
06/18/2010
Last updated
07/21/2022
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