Healthcare Provider Details

I. General information

NPI: 1275755886
Provider Name (Legal Business Name): YERUVA VEERA MADHU MOHAN REDDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CAMBRIDGE ST STE G600
KANSAS CITY KS
66160-8500
US

IV. Provider business mailing address

4000 CAMBRIDGE ST STE G600
KANSAS CITY KS
66160-8501
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-9600
  • Fax: 913-588-9770
Mailing address:
  • Phone: 913-588-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number04-36641
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2013027477
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number2013027477
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number04-36641
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: