Individual
ANUPAMA NUTAKKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3048 E BASELINE RD STE 120, MESA, AZ 85204-7288
(480) 505-3276
(480) 505-3288
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(025) 793-2037
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
33663
AZ
208000000X
Pediatrics Physician
33663
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128721
—
AZ
Enumeration date
03/28/2006
Last updated
11/22/2023
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