Provider Demographics
NPI:1093399933
Name:KOTLO, SRISHA R (MD)
Entity type:Individual
Prefix:
First Name:SRISHA
Middle Name:R
Last Name:KOTLO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 FANNIN ST STE 600
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-5206
Mailing Address - Country:US
Mailing Address - Phone:832-325-7100
Mailing Address - Fax:713-512-2242
Practice Address - Street 1:6410 FANNIN ST STE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5206
Practice Address - Country:US
Practice Address - Phone:832-325-7100
Practice Address - Fax:713-512-2242
Is Sole Proprietor?:No
Enumeration Date:2021-05-06
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.079716207R00000X
390200000X
TXTBD207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program