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Individual

DR. MANJUNATH SHIVAMANYA KOTTALGI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
612 W BASELINE RD, MESA, AZ 85210-6041
(480) 834-9039
(480) 964-7802
Mailing address
612 W BASELINE RD, MESA, AZ 85210-6041
(480) 834-9039
(480) 964-7802

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125055930
IL
207RN0300X
Nephrology Physician
Primary
48589
AZ

Other

Enumeration date
11/12/2009
Last updated
05/18/2014
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