Provider Demographics
NPI:1346294485
Name:REDDY, BHIMAVARAPU KRISHNAMOHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BHIMAVARAPU
Middle Name:KRISHNAMOHAN
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 1:1 ELIZABETH PL
Mailing Address - Street 2:SUITE # 230
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45408-1445
Mailing Address - Country:US
Mailing Address - Phone:937-222-2233
Mailing Address - Fax:937-222-9665
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:SUITE # 230
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408-1445
Practice Address - Country:US
Practice Address - Phone:937-222-2233
Practice Address - Fax:937-222-9665
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-5932-R207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35-03-5932ROtherOHIO LICENSE
OH0339879Medicaid
OH0339879Medicaid
OHC01494Medicare UPIN