Provider Demographics
NPI:1275535536
Name:REDDY, VINAY KUMAR PUCHALAPALLI (MD)
Entity Type:Individual
Prefix:DR
First Name:VINAY
Middle Name:KUMAR PUCHALAPALLI
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 1:118 E 90TH DR
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7160
Mailing Address - Country:US
Mailing Address - Phone:219-736-2922
Mailing Address - Fax:219-736-2938
Practice Address - Street 1:118 E 90TH DR
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7160
Practice Address - Country:US
Practice Address - Phone:219-736-2922
Practice Address - Fax:219-736-2938
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056231A207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000322080OtherANTHEM PROVIDER NUMBER
IN000000322080OtherANTHEM PROVIDER NUMBER
ING12919Medicare UPIN
IN216920AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER