Provider Demographics
NPI:1790742682
Name:VATTIKUTI, RADHIKA (MD)
Entity Type:Individual
Prefix:DR
First Name:RADHIKA
Middle Name:
Last Name:VATTIKUTI
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 1:15640 N 28TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4059
Mailing Address - Country:US
Mailing Address - Phone:602-439-9000
Mailing Address - Fax:602-978-5233
Practice Address - Street 1:15640 N 28TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4059
Practice Address - Country:US
Practice Address - Phone:602-439-9000
Practice Address - Fax:602-978-5233
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34270174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00373224OtherRAILROAD
AZI41532Medicare UPIN
AZP00373224OtherRAILROAD
AZZ120732Medicare PIN