Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 4301100755 | MI |
Y | 207VX0000X | Obstetrician | MD2016-0236 | NM |
NPI | 1215292339 |
---|---|
Provider Name | Dr. Vivek Katukuri |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Albuquerque, NM 87131-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2012 |
Last Update Date | 14/08/2019 |