Basic Information
Provider Information | |||||||||
NPI: | 1457461709 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | UTTURKAR & ASSOCIATES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 260 RESACA POINT RD | ||||||||
Address2: |   | ||||||||
City: | BROWNSVILLE | ||||||||
State: | TX | ||||||||
PostalCode: | 785264091 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9565810303 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 100 E ALTON GLOOR BLVD STE A | ||||||||
Address2: |   | ||||||||
City: | BROWNSVILLE | ||||||||
State: | TX | ||||||||
PostalCode: | 785263354 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9565810303 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/30/2006 | ||||||||
LastUpdateDate: | 08/01/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | UTTURKAR | ||||||||
AuthorizedOfficialFirstName: | ANANT | ||||||||
AuthorizedOfficialMiddleName: | K | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 9565810303 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X |   |   | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
ID | Type | State | Issuer | Description | 188196301 | 05 | TX |   | MEDICAID | 0074PS | 01 | TX | BC BS TEXAS | OTHER | 137848113 | 05 | TX |   | MEDICAID |