Provider Demographics
NPI:1114367869
Name:NUTALAPATI, VENKAT PRIDHVI (MBBS)
Entity Type:Individual
Prefix:DR
First Name:VENKAT
Middle Name:PRIDHVI
Last Name:NUTALAPATI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11311 BRIDGEPORT WAY SW STE 207
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3051
Mailing Address - Country:US
Mailing Address - Phone:253-272-8664
Mailing Address - Fax:253-627-7880
Practice Address - Street 1:11311 BRIDGEPORT WAY SW STE 207
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3051
Practice Address - Country:US
Practice Address - Phone:253-272-8664
Practice Address - Fax:253-627-7880
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD61274732207RG0100X
KS04-38964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2211808Medicaid