Provider Demographics
NPI:1205821170
Name:REDDY, PURUSHOTTAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:PURUSHOTTAM
Middle Name:M
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 1:14134 NEPHRONE LANE
Mailing Address - Street 2:RENAL HYPERTENSION CENTER
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667
Mailing Address - Country:US
Mailing Address - Phone:727-863-5418
Mailing Address - Fax:727-869-8626
Practice Address - Street 1:14134 NEPHRON LANE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-863-5418
Practice Address - Fax:727-869-8626
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME005664207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
593068073OtherHUMANA MILITARY
593068073OtherPCHS
110069456OtherMEDICARE RR
1042OtherOPTIMUM
2217334OtherCIGNA
FL052954100Medicaid
210962OtherAV-MED
593068073OtherSOUTHCARE
0004106456OtherAETNA
01245OtherUNIVERSAL
593068073OtherHUMANA
933673OtherCCN
09594OtherWELLCARE
10501601OtherCITRUS HEALTH CARE
2504281OtherGHI
933673OtherFIRST HEALTH
PRO127OtherQUALITY DELTA
01245OtherUNIVERSAL
933673OtherFIRST HEALTH
593068073OtherHUMANA