Individual
DEEPAK GUTTIKONDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8075 N SHADELAND AVE STE 330, INDIANAPOLIS, IN 46250-2694
(317) 353-7220
(317) 355-9672
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
01057922A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000525348
ANTHEM
IN
05
—
200456610
—
IN
01
—
7014504
AETNA
IN
01
—
P01214609
RR MEDICARE PTAN
IN
Enumeration date
06/30/2006
Last updated
06/11/2021
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