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NPI Code Detail

MEDICARE: DR. RADHIKA VATTIKUTI M.D.

MEDICARE: DR. RADHIKA VATTIKUTI M.D.
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
1174400000XSpecialist34270AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00373224OTHERAZRAILROAD

General Provider Information

NPI Number : 1790742682
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RADHIKA VATTIKUTI M.D.
Provider Business Mailing Address
First Line : 15640 N 28TH DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85053-4059
Country : US
Telephone Number : 602-439-9000
Fax Number : 602-978-5233
Provider Business Practice Location Address
First Line : 15640 N 28TH DR
Second Line :
City : PHOENIX
State : AZ
Zip : 85053-4059
Country : US
Telephone Number : 602-439-9000
Fax Number : 602-978-5233
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 12/17/2013

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