Healthcare Provider Details

I. General information

NPI: 1629495973
Provider Name (Legal Business Name): PRANEETH KUDARAVALLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 SIERRA ROSE DR
RENO NV
89511-2060
US

IV. Provider business mailing address

655 SIERRA ROSE DR
RENO NV
89511-2060
US

V. Phone/Fax

Practice location:
  • Phone: 775-829-7600
  • Fax:
Mailing address:
  • Phone: 775-829-6700
  • Fax: 775-829-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDR.0073095
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number88415
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number26787
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number51420
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51420
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number88415
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: