Healthcare Provider Details

I. General information

NPI: 1518008440
Provider Name (Legal Business Name): Y K REDDY MD APMC ASTHMA AND ALLERGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 SHED RD SUITE A
BOSSIER CITY LA
71111-3154
US

IV. Provider business mailing address

PO BOX 5189
BOSSIER CITY LA
71171-5189
US

V. Phone/Fax

Practice location:
  • Phone: 318-549-3500
  • Fax:
Mailing address:
  • Phone: 318-549-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number11407R
License Number StateLA

VIII. Authorized Official

Name: KAMALAKAR REDDY YATURU
Title or Position: OWNER
Credential: M.D.
Phone: 318-549-3500