MEDICARE: DHARANI GUTTIKONDA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RT0003X	Transplant Hepatology Physician	75705	WI
2	207R00000X	Internal Medicine Physician	036.146432	IL
3	207RG0100X	Gastroenterology Physician	036146432	IL

General Provider Information

NPI Number	:	1154717684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DHARANI GUTTIKONDA

Provider Business Mailing Address
First Line	:	3301 W FOREST HOME AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-2843
Country	:	US
Telephone Number	:	414-649-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 W OKLAHOMA AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-4330
Country	:	US
Telephone Number	:	414-489-4190
Fax Number	:

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

Provider Enumeration Date	:	04/10/2015
Last Update Date	:	01/12/2025

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Directions to “ DHARANI GUTTIKONDA ” Practice Location

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