Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Manjunath Shivamanya Kottalgi, MD

Individual provider Internal Medicine Physician · NPI 1497082432

Dr. Manjunath Shivamanya Kottalgi, MD is a Nephrology in Mesa, Arizona. Qualified in 2007, 19 years ago. Practices with Banner - University Super Specialists LLC, a 32-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Arizona and Illinois.

Years since qualifying
19
Licensed in
AZ, IL
In the registry since
2009
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

612 W Baseline Rd
Mesa, AZ 85210-6041
Phone: (480) 834-9039
Fax: (480) 964-7802
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nephrology Physician (primary) Taxonomy 207RN0300X · Licence 48589 (AZ)
Internal Medicine Physician Taxonomy 207R00000X · Licence 125055930 (IL)

Record details

NPI number1497082432
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedNovember 12, 2009
Last updated in NPPESMay 18, 2014

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNEPHROLOGY
Also practisesINTERNAL MEDICINE
Medical schoolOTHER
Graduated 2007 (19 years in practice)
Group practice Banner - University Super Specialists Llc — 32 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

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