Provider Demographics
NPI:1447570114
Name:REDDY, AVINASH KONUDULLA (MD)
Entity Type:Individual
Prefix:
First Name:AVINASH
Middle Name:KONUDULLA
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 1:17682 GEORGE MORAN DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1085
Mailing Address - Country:US
Mailing Address - Phone:952-836-4449
Mailing Address - Fax:952-934-5030
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:ROOM 374
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-859-7756
Practice Address - Fax:716-859-7760
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280760-1208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology