Healthcare Provider Details

I. General information

NPI: 1659061091
Provider Name (Legal Business Name): SAI DEEPIKA GUDAPATI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HURLEY PLZ OFC 10W
FLINT MI
48503-5902
US

IV. Provider business mailing address

1 HURLEY PLZ OFC 10W
FLINT MI
48503-5902
US

V. Phone/Fax

Practice location:
  • Phone: 810-262-9000
  • Fax:
Mailing address:
  • Phone: 810-262-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: