Individual
CHAITANYA KRISHNA KOTAGIRI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1103 W LIBERTY ST, FARMINGTON, MO 63640-1921
(573) 756-6751
(573) 756-6807
Mailing address
1101 W LIBERTY ST, FARMINGTON, MO 63640-1921
(573) 751-6751
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
125-054995
IL
207Q00000X
Family Medicine Physician
2011017860
MO
208M00000X
Hospitalist Physician
Primary
2011017860
MO
Other
Enumeration date
06/24/2008
Last updated
03/19/2021
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