Provider Demographics
NPI:1437140332
Name:LOKAREDDY, SURENDHER (MD)
Entity Type:Individual
Prefix:DR
First Name:SURENDHER
Middle Name:
Last Name:LOKAREDDY
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 1:1945 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6105
Mailing Address - Country:US
Mailing Address - Phone:928-341-4650
Mailing Address - Fax:928-341-9779
Practice Address - Street 1:1945 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6105
Practice Address - Country:US
Practice Address - Phone:928-341-4650
Practice Address - Fax:928-341-9779
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22345207V00000X
PAMD048704L207V00000X
NY195056207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0376540OtherBC/BS
AZ629222OtherAETNA
AZ167082Medicaid
AZ4280300OtherCIGNA PROVIDER ID
AZ629222OtherAETNA
AZ4280300OtherCIGNA PROVIDER ID