Healthcare Provider Details

I. General information

NPI: 1558749218
Provider Name (Legal Business Name): KIRAN KUMAR REDDY BUSIREDDY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 03/05/2022
Certification Date: 03/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 30TH ST
OMAHA NE
68131-2128
US

IV. Provider business mailing address

2665 HOWARD CMNS APT 13
HOWARD WI
54313-9379
US

V. Phone/Fax

Practice location:
  • Phone: 402-449-4000
  • Fax:
Mailing address:
  • Phone: 253-397-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number76426-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: