MEDICARE: NARENDRA BABU GUTTA

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
1	2085R0204X	Vascular & Interventional Radiology Physician	2021001840	MO
2	2085R0202X	Diagnostic Radiology Physician	2021001840	MO

General Provider Information

NPI Number	:	1619397460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NARENDRA BABU GUTTA

Provider Business Mailing Address
First Line	:	70 DOCTORS PARK
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-4928
Country	:	US
Telephone Number	:	573-334-6071
Fax Number	:	573-334-4739

Provider Business Practice Location Address
First Line	:	70 DOCTORS PARK
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-4928
Country	:	US
Telephone Number	:	573-334-6071
Fax Number	:	573-334-4739

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2014
Last Update Date	:	04/09/2026

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Directions to “ NARENDRA BABU GUTTA ” Practice Location

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