Basic Information
| Provider Information | |||||||||
| NPI: | 1477084366 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOTTULA | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | LAERTES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 231 ALBERT SABIN WAY | ||||||||
| Address2: | MSB 1654 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452670769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135888114 | ||||||||
| FaxNumber: | 5135585791 | ||||||||
| Practice Location | |||||||||
| Address1: | 234 GOODMAN ST | ||||||||
| Address2: | CENTER FOR EMERGENCY CARE | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135588114 | ||||||||
| FaxNumber: | 5135585791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2017 | ||||||||
| LastUpdateDate: | 05/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35.138703 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.