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General NPI Number Information
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NPI Number | 1114205838
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Entity Type | Individual
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Provider Name | CHIRANJEEVI PRAMODNATH REDDY SIDDAGUNTA MBBS
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Gender | Male
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 2123 AUBURN AVE STE 440
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City | CINCINNATI
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State | OH
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Zip | 45219-2906
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Country | US
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Telephone | 513-648-8980
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Fax | 513-648-8988
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Provider Business Mailing Address
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Address Line | 2123 AUBURN AVE STE 440
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City | CINCINNATI
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State | OH
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Zip | 45219-2906
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Country | US
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Telephone | 513-648-8980
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Fax | 513-648-8988
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD-44640
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number | MD-44640
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 207QS1201X
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Taxonomy Name | Sleep Medicine (Family Medicine) Physician
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License Number | 35.C000357
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License Number State | OH
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