Provider Demographics
NPI:1407977242
Name:REDDY, DEEPIKA SANTOSH (MD)
Entity Type:Individual
Prefix:
First Name:DEEPIKA
Middle Name:SANTOSH
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 I ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-3009
Mailing Address - Country:US
Mailing Address - Phone:254-421-2672
Mailing Address - Fax:
Practice Address - Street 1:615 S ARAPEEN DR STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1239
Practice Address - Country:US
Practice Address - Phone:254-421-2672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9021210-1205207RE0101X
TXN1098207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism