Basic Information
| Provider Information | |||||||||
| NPI: | 1093906216 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAMINDLA | ||||||||
| FirstName: | DEEPTHI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MBBS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4229 N 90TH ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681344136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024016000 | ||||||||
| FaxNumber: | 4024016015 | ||||||||
| Practice Location | |||||||||
| Address1: | 4229 NORTH 90TH STREET | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024016000 | ||||||||
| FaxNumber: | 4024016015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2007 | ||||||||
| LastUpdateDate: | 07/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 26060 | NE | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.