Provider Demographics
NPI:1083666762
Name:REDDY, RAM K (MD)
Entity Type:Individual
Prefix:
First Name:RAM
Middle Name:K
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 940220
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-0220
Mailing Address - Country:US
Mailing Address - Phone:407-384-1718
Mailing Address - Fax:407-384-1806
Practice Address - Street 1:7824 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE H
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8201
Practice Address - Country:US
Practice Address - Phone:407-384-1718
Practice Address - Fax:407-384-1806
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375759500Medicaid
FL23514OtherBCBS PROVIDER NUMBER
F72382Medicare UPIN
FL23514AMedicare ID - Type UnspecifiedINDIVIDUAL FLA MEDICARE N