Provider Demographics
NPI:1437941754
Name:MUTYALA, NITESH (MBBS)
Entity type:Individual
Prefix:MR
First Name:NITESH
Middle Name:
Last Name:MUTYALA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49/40/9 SRI KESAVA RESIDENCY FLAT TF1 AKKAYYA
Mailing Address - Street 2:FLAT TF1 THIRD FLOOR
Mailing Address - City:VISAKHAPATNAM
Mailing Address - State:ANDHRA PRADESH
Mailing Address - Zip Code:530016
Mailing Address - Country:IN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2525 S. MICHIGAN AVE INSIGHT HOSPITAL AND MEDICAL CENTE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616
Practice Address - Country:US
Practice Address - Phone:312-567-2397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.085244390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program