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General NPI Number Information
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NPI Number | 1073542346
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Entity Type | Individual
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Provider Name | DEEPAK GUTTIKONDA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 06/11/2021
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Provider Practice Location Address
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Address Line | 8075 N SHADELAND AVE STE 330
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2694
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Country | US
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Telephone | 317-353-7220
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Fax | 317-355-9672
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Provider Business Mailing Address
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Address Line | 6626 E 75TH ST SUITE 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2805
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 01057922A
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License Number State | IN
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