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General NPI Number Information
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NPI Number | 1710369160
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Entity Type | Individual
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Provider Name | DEEPTHI THOTAKURA M.D
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Gender | Female
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Dates
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Enumeration Date | 06/22/2015
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 1105 CENTRAL EXPY N STE 320
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City | ALLEN
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State | TX
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Zip | 75013-6104
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Country | US
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Telephone | 469-467-4392
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Fax | 469-342-6750
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Provider Business Mailing Address
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Address Line | PO BOX 911230
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City | DALLAS
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State | TX
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Zip | 75391-1230
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Country | US
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Telephone | 972-997-9800
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Fax | 972-234-2987
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | BP10054296
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | R7616
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | R7616
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License Number State | TX
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