Provider Demographics
NPI:1003981135
Name:REDDY, ANIL KUMAR (MD)
Entity Type:Individual
Prefix:MR
First Name:ANIL
Middle Name:KUMAR
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9725 EAST 79TH STREET
Mailing Address - Street 2:SUIT A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4569
Mailing Address - Country:US
Mailing Address - Phone:918-252-0112
Mailing Address - Fax:918-252-0103
Practice Address - Street 1:9725 EAST 79TH STREET
Practice Address - Street 2:SUIT A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4569
Practice Address - Country:US
Practice Address - Phone:918-252-0112
Practice Address - Fax:918-252-0103
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK215352081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200216530AMedicaid
OK100010230BMedicaid
OK800522184Medicare PIN
OK800522189Medicare ID - Type Unspecified
OKH15045Medicare UPIN