Healthcare Provider Details

I. General information

NPI: 1023067881
Provider Name (Legal Business Name): DHANUNJAYA LAKKIREDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 01/27/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD SUITE#G600
KANSAS CITY KS
66160-8500
US

IV. Provider business mailing address

5501 NW 62ND TER SUITE 201
KANSAS CITY MO
64151-2411
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-9600
  • Fax: 913-588-9770
Mailing address:
  • Phone: 816-584-8884
  • Fax: 913-945-9612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number04-29029
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number117378
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number117378
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number04-29029
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: