Healthcare Provider Details

I. General information

NPI: 1316911431
Provider Name (Legal Business Name): CHANDRA MOHAN REDDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 EAST HAPPY VALLEY ST.
CAVE CITY KY
42127-8844
US

IV. Provider business mailing address

793 STEEPLECHASE RD
GLASGOW KY
42141
US

V. Phone/Fax

Practice location:
  • Phone: 270-773-2121
  • Fax: 270-773-2120
Mailing address:
  • Phone: 270-678-5365
  • Fax: 270-678-3996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number32087
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number32087
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: