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PHANINDRA GADDIPATI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1959 NE PACIFIC ST, RR210, SEATTLE, WA 98195-2529
(719) 338-2263
Mailing address
502 E SPRINGFIELD AVE APT 305, CHAMPAIGN, IL 61820-5587
(719) 338-2263

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125.079926
IL
2085R0202X
Diagnostic Radiology Physician
Primary
MDRE.ML.61424792
WA

Other

Enumeration date
05/17/2022
Last updated
05/03/2023
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