MEDICARE: DEEPAK GUTTIKONDA M.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	01057922A	IN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01214609	OTHER	IN	RR MEDICARE PTAN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7014504	OTHER	IN	AETNA
4	000000525348	OTHER	IN	ANTHEM

NPI Number	:	1073542346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEPAK GUTTIKONDA M.D.

Provider Business Mailing Address
First Line	:	6626 E 75TH ST
Second Line	:	SUITE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8075 N SHADELAND AVE STE 330
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2694
Country	:	US
Telephone Number	:	317-353-7220
Fax Number	:	317-355-9672

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	06/11/2021

8075 N SHADELAND AVE STE 330
INDIANAPOLIS, IN
46250-2694

Practice Phone: 317-355-7220
Practice Fax:

8075 N SHADELAND AVE STE 200
INDIANAPOLIS, IN
46250-2694