Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 01075966A | IN |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 52061-20 | WI |
NPI | 1013133222 |
---|---|
Provider Name | Vijay Krishna Nuthakki |
First Address | Indianapolis, IN 46268-3129 |
Second Address | Indianapolis, IN 46260-2193 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 25/01/2016 |