Provider Demographics
NPI:1679531529
Name:HOTCHANDANI, GOPE C (MD)
Entity type:Individual
Prefix:
First Name:GOPE
Middle Name:C
Last Name:HOTCHANDANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2771 RAMADA WAY
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5759
Mailing Address - Country:US
Mailing Address - Phone:920-497-9996
Mailing Address - Fax:920-497-9908
Practice Address - Street 1:2771 RAMADA WAY
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5759
Practice Address - Country:US
Practice Address - Phone:920-497-9996
Practice Address - Fax:920-497-9908
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41587020208600000X
MI4301055889208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000004135Medicare ID - Type Unspecified
WI000004135Medicare ID - Type Unspecified