Basic Information
| Provider Information | |||||||||
| NPI: | 1003130618 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOTTEY | ||||||||
| FirstName: | JANAME | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MBBS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 N 1900 E RM 4R312 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841320002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015816709 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13154 COIT RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752405787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143582300 | ||||||||
| FaxNumber: | 2145796989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 11266127-1205 | UT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207R00000X | 47750 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 16945 | NV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | T0265 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 208M00000X | 47750 | AZ | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | T0265 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | T0265 | 01 | TX | TEXAS LICENSE | OTHER |