# DEEPAK GUTTIKONDA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1073542346
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 01057922A | IN | Yes |

## Other

- **Enumeration date:** 06/30/2006
- **Last updated:** 06/11/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000525348 | ANTHEM | IN |
| 05 | — | 200456610 | — | IN |
| 01 | — | 7014504 | AETNA | IN |
| 01 | — | P01214609 | RR MEDICARE PTAN | IN |