Provider Demographics
NPI:1053386623
Name:KATYAL, DEEPAK (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:
Last Name:KATYAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-265-2895
Mailing Address - Fax:256-265-9777
Practice Address - Street 1:201 SIVLEY RD SW
Practice Address - Street 2:SUITE 400
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5134
Practice Address - Country:US
Practice Address - Phone:256-265-2895
Practice Address - Fax:256-265-9777
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19955208600000X, 2086S0102X, 2086S0127X
AL000199552086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051031307OtherBCBS
AL000031307Medicaid
AL000031307Medicare PIN
AL020040254Medicare PIN
ALG35167Medicare UPIN
AL051031307OtherBCBS
TN4045901OtherMEDICAID OF TENNESSEE
LA1479756OtherLOUISIANA MEDICAID