Provider Demographics
NPI:1144288408
Name:KOTTAPALLI, VEN (MD, CNSP)
Entity type:Individual
Prefix:
First Name:VEN
Middle Name:
Last Name:KOTTAPALLI
Suffix:
Gender:M
Credentials:MD, CNSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 N CABLE RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2133
Mailing Address - Country:US
Mailing Address - Phone:419-228-2600
Mailing Address - Fax:419-228-1100
Practice Address - Street 1:512 N CABLE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2133
Practice Address - Country:US
Practice Address - Phone:419-228-2600
Practice Address - Fax:419-228-1100
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078041207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000243040OtherANTHEM
OH2205278Medicaid
OH5539641OtherAETNA
OH4020507Medicare PIN
OH000000243040OtherANTHEM