Healthcare Provider Details

I. General information

NPI: 1780778746
Provider Name (Legal Business Name): KRISHNA M. MALIREDDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W 8TH AVE SUITE 7060
SPOKANE WA
99204-2302
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-340-0930
  • Fax: 509-747-2054
Mailing address:
  • Phone: 866-747-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD00041214
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: