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NPI Code Detail

MEDICARE: DR. RENUKA REDDY M.D.

MEDICARE: DR. RENUKA 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
1207Q00000XFamily Medicine Physician37785KY

Other Identifiers

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

General Provider Information

NPI Number : 1992817522
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RENUKA REDDY M.D.
Provider Business Mailing Address
First Line : 401 GRAND OAK LN
Second Line :
City : HAZARD
State : KY
Zip : 41701-9430
Country : US
Telephone Number : 606-439-4484
Fax Number : 606-439-0575
Provider Business Practice Location Address
First Line : 1908 N MAIN ST
Second Line :
City : HAZARD
State : KY
Zip : 41701-2505
Country : US
Telephone Number : 606-439-2662
Fax Number : 606-439-0575
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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