MEDICARE: MR. CHANDRA MOHAN REDDY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	32087	KY
2	207R00000X	Internal Medicine Physician	32087	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316911431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHANDRA MOHAN REDDY M.D.

Provider Business Mailing Address
First Line	:	793 STEEPLECHASE RD
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42141
Country	:	US
Telephone Number	:	270-678-5365
Fax Number	:	270-678-3996

Provider Business Practice Location Address
First Line	:	440 EAST HAPPY VALLEY ST.
Second Line	:
City	:	CAVE CITY
State	:	KY
Zip	:	42127-8844
Country	:	US
Telephone Number	:	270-773-2121
Fax Number	:	270-773-2120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	01/07/2009

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