Healthcare Provider Details

I. General information

NPI: 1760613780
Provider Name (Legal Business Name): KIRAN NARREDDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2009
Last Update Date: 07/13/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PEACEHEALTH HOSPITAL MEDICINE, 3377 RIVERBEND DRIVE
SPRINGFIELD OR
97477
US

IV. Provider business mailing address

PEACEHEALTH HOSPITAL MEDICINE, 3377 RIVERBEND DRIVE
SPRINGFIELD OR
97477
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-6389
  • Fax: 541-222-6385
Mailing address:
  • Phone: 541-222-6389
  • Fax: 541-222-6385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD171587
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD171587
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: