Provider Demographics
NPI:1932363249
Name:ANANT K UTTURKAR
Entity Type:Organization
Organization Name:ANANT K UTTURKAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANANT
Authorized Official - Middle Name:K
Authorized Official - Last Name:UTTURKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-581-0303
Mailing Address - Street 1:PO BOX 52236
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78505-2236
Mailing Address - Country:US
Mailing Address - Phone:956-581-0303
Mailing Address - Fax:
Practice Address - Street 1:100 ALTON GLOOR BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521
Practice Address - Country:US
Practice Address - Phone:956-350-7525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG24982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137848101Medicaid
TX300006992Medicare PIN
TX137848101Medicaid
TX00DM73Medicare PIN