Provider Demographics
NPI:1225599194
Name:GUTTA, RADHIKA (DO)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:GUTTA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6272 CANTER CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7440
Mailing Address - Country:US
Mailing Address - Phone:810-869-9800
Mailing Address - Fax:
Practice Address - Street 1:122 E 76TH ST STE 3A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2823
Practice Address - Country:US
Practice Address - Phone:212-434-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program