Provider Demographics
NPI:1407050073
Name:GUTTIKONDA, SREEDEVI NONESUPPLIED (MBBS)
Entity Type:Individual
Prefix:DR
First Name:SREEDEVI
Middle Name:NONESUPPLIED
Last Name:GUTTIKONDA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 N BELT LINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-1795
Mailing Address - Country:US
Mailing Address - Phone:972-682-5700
Mailing Address - Fax:972-682-5703
Practice Address - Street 1:1621 N BELT LINE RD STE A
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-1795
Practice Address - Country:US
Practice Address - Phone:972-682-5700
Practice Address - Fax:972-682-5703
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0026433207R00000X
TXN7544207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3857039172OtherMYUTMB 3857039172-COMMERCIAL NUMBER