Individual
TERRI LYNN BOTT-KOTHARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5950 METRO WAY SW, WYOMING, MI 49519-9514
(616) 252-8160
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
077359
MI
2085R0001X
Radiation Oncology Physician
Primary
4301077359
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4284064
—
MI
01
—
920006063
RAILROAD MEDICARE
MI
Enumeration date
07/12/2006
Last updated
11/19/2011
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