Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | M0417 | TX |
Y | 2084N0400X | Neurologist | M0417 | TX |
NPI | 1235165754 |
---|---|
Provider Name | Anita Gottipati |
First Address | Shenandoah, TX 77380-3482 |
Second Address | Cleveland, TX 77327 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2006 |
Last Update Date | 26/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
173172101 | (05) | TX |
I00666 | (02) |