Healthcare Provider Details

I. General information

NPI: 1770534745
Provider Name (Legal Business Name): MAHESH REDDY KUTHURU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 WEST CHARLESTON BOULEVARD SUITE 207
LAS VEGAS NV
89146-0000
US

IV. Provider business mailing address

5701 WEST CHARLESTON BOULEVARD SUITE 207
LAS VEGAS NV
89146-0000
US

V. Phone/Fax

Practice location:
  • Phone: 702-240-8318
  • Fax: 702-240-8331
Mailing address:
  • Phone: 702-240-8318
  • Fax: 702-240-8331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number215662
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: