Individual
DEEPIKA KAKKERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1201 S MAIN ST, CROWN POINT, IN 46307-8481
(219) 757-5887
(219) 757-6481
Mailing address
PO BOX 1000, DYER, IN 46311-0800
(219) 864-2107
(219) 864-2649
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
01053443A
IN
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
01053443A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000906352
ANTHEM PROVIDER NUMBER
IN
01
—
0090000854
BCBS GROUP NUMBER
IL
05
—
200319850
—
IN
Enumeration date
09/29/2005
Last updated
11/20/2023
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