Provider Demographics
NPI:1255325171
Name:REDDY, KUCHAKULLA NARASIMHA (M D)
Entity Type:Individual
Prefix:
First Name:KUCHAKULLA
Middle Name:NARASIMHA
Last Name:REDDY
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 SW 1ST AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6515
Mailing Address - Country:US
Mailing Address - Phone:352-433-2971
Mailing Address - Fax:877-319-1704
Practice Address - Street 1:1627 SW 1ST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-433-2971
Practice Address - Fax:877-319-1704
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66726207R00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375915600Medicaid
FL375915600Medicaid
FL25703XMedicare ID - Type Unspecified