| Kota Medical Pc | |
|
3630 Willowcreek Rd Portage IN 46368-5075 | |
| (219) 759-5812 | |
| (219) 759-5890 |
| Full Name | Kota Medical Pc |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 3630 Willowcreek Rd, Portage, Indiana |
| Authorized Official Name and Position | Ranga Rao Kota (OWNER) |
| Authorized Official Contact | 2197595812 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kota Medical Pc 3630 Willowcreek Rd Portage IN 46368-5075 Ph: (219) 759-5812 | Kota Medical Pc 3630 Willowcreek Rd Portage IN 46368-5075 Ph: (219) 759-5812 |
| NPI Number | 1063668614 |
|---|---|
| Provider Enumeration Date | 08/14/2008 |
| Last Update Date | 03/28/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063668614 | NPI | - | NPPES |
| 200007810 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 01038987 (Indiana) | Secondary |
| 207RG0100X | Internal Medicine - Gastroenterology | 01038987 (Indiana) | Primary |
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