Provider Demographics
NPI:1235113259
Name:REDDY, KARUNA GHANTA (MD)
Entity Type:Individual
Prefix:DR
First Name:KARUNA
Middle Name:GHANTA
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-598-9595
Mailing Address - Fax:270-598-9590
Practice Address - Street 1:1112 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-2371
Practice Address - Country:US
Practice Address - Phone:270-598-9595
Practice Address - Fax:270-598-9590
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36342207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH33135Medicare UPIN