Individual
DR. VASUDHA KOTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
940 W MOUNT VERNON ST STE 200, NIXA, MO 65714-9613
(417) 724-5200
Mailing address
4201 ST. ANTOINE, UHC 9C, GRADUATE MEDICAL EDUCATION, DETROIT, MI 48201
(313) 745-6047
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2023026693
MO
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/23/2020
Last updated
07/14/2023
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