Kothur, Praveena R

Kothur, Praveena R is an sole proprietor health care provider with primary practice located at 4901 N 44Th St Ste 103 , Phoenix AZ 85018-2782. She recently has only one registered license in Allopathic & Osteopathic Physicians / Allergy & Immunology, which is considered as her primary health care specialty. Kothur, Praveena R can be contacted via phone (602) 954-0405.

Contact Information

Primary practice address
4901 N 44Th St Ste 103 Phoenix AZ 85018-2782
Phone: (602) 954-0405
Fax: (602) 954-0485
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Allergy & Immunology 207K00000X 30666 Arizona

Profile Details

NPI number 1114973179
LBN Legal business name Kothur, Praveena R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 25th, 2006
Last updated Jan 2nd, 2024 - about 11 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114973179 NPPES
Arizona MEDICAID 792053
Arizona Other Z302567

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