Individual
JYOSTNA DEEPIKA PULLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 266-2020
(260) 266-2009
Mailing address
1313 WINDING RIDGE DR APT 2B, GRAND BLANC, MI 48439-7553
(484) 343-8071
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301100546
MI
208000000X
Pediatrics Physician
4301100546
MI
Other
Enumeration date
08/05/2012
Last updated
04/25/2016
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