Provider Demographics
NPI:1235578220
Name:REDDY, CHANAKYARAM AYYADAP (MD)
Entity Type:Individual
Prefix:
First Name:CHANAKYARAM
Middle Name:AYYADAP
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 1:3417 GASTON AVE STE 1000
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2037
Mailing Address - Country:US
Mailing Address - Phone:469-800-7050
Mailing Address - Fax:
Practice Address - Street 1:3417 GASTON AVE STE 1000
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2037
Practice Address - Country:US
Practice Address - Phone:469-800-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-23
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013020047207R00000X
MI4301109306207R00000X, 207RG0100X
TXS7124207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine