Provider Demographics
NPI:1790017614
Name:PATTANSHETTY, DEEPAK JAYANANDA (MD, MRCP(UK))
Entity type:Individual
Prefix:
First Name:DEEPAK
Middle Name:JAYANANDA
Last Name:PATTANSHETTY
Suffix:
Gender:M
Credentials:MD, MRCP(UK)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 775383
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5383
Mailing Address - Country:US
Mailing Address - Phone:812-376-5315
Mailing Address - Fax:
Practice Address - Street 1:2325 18TH ST STE 130
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5387
Practice Address - Country:US
Practice Address - Phone:812-379-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY51556207RI0011X
IN01094590A207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology