Provider Demographics
NPI:1336594191
Name:KOTAPATI, SUJIT KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:SUJIT KUMAR
Middle Name:
Last Name:KOTAPATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SUJIT
Other - Middle Name:KUMAR
Other - Last Name:KOTAPATI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6929 JOHN F KENNEDY BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-5358
Mailing Address - Country:US
Mailing Address - Phone:501-235-8295
Mailing Address - Fax:501-471-0771
Practice Address - Street 1:6929 JOHN F KENNEDY BLVD STE 104
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-5358
Practice Address - Country:US
Practice Address - Phone:501-235-8295
Practice Address - Fax:501-471-0771
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-14472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine