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NPI Code Detail

MEDICARE: DEEPIKA SANTOSH REDDY MD

MEDICARE: DEEPIKA SANTOSH REDDY MD
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
1207RE0101XEndocrinology, Diabetes & Metabolism Physician9021210-1205UT
2207RE0101XEndocrinology, Diabetes & Metabolism PhysicianN1098TX

General Provider Information

NPI Number : 1407977242
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEEPIKA SANTOSH REDDY MD
Provider Business Mailing Address
First Line : 236 I ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84103-3009
Country : US
Telephone Number : 254-421-2672
Fax Number :
Provider Business Practice Location Address
First Line : 615 S ARAPEEN DR STE 100
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-1239
Country : US
Telephone Number : 254-421-2672
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2007
Last Update Date : 11/12/2021

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