MEDICARE: MRS. SUGUNA V REDDY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	18326	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	617610	OTHER	KS	HEALTHWAVE

General Provider Information

NPI Number	:	1215935812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUGUNA V REDDY MD

Provider Business Mailing Address
First Line	:	700 W CENTRAL AVE
Second Line	:	STE 108
City	:	EL DORADO
State	:	KS
Zip	:	67042-2184
Country	:	US
Telephone Number	:	316-321-7550
Fax Number	:	316-321-1404

Provider Business Practice Location Address
First Line	:	700 W CENTRAL AVE
Second Line	:	STE 108
City	:	EL DORADO
State	:	KS
Zip	:	67042-2184
Country	:	US
Telephone Number	:	316-321-7550
Fax Number	:	316-321-1404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	08/04/2009

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Directions to “ MRS. SUGUNA V REDDY MD” Practice Location

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