Provider Demographics
NPI:1467554139
Name:REDDY, KUNADI S (MD)
Entity Type:Individual
Prefix:DR
First Name:KUNADI
Middle Name:S
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 1:414 PERRY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1467
Mailing Address - Country:US
Mailing Address - Phone:810-694-8423
Mailing Address - Fax:810-694-9280
Practice Address - Street 1:414 PERRY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1467
Practice Address - Country:US
Practice Address - Phone:810-694-8423
Practice Address - Fax:810-694-9280
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2011-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3384243Medicaid
MIG54163Medicare UPIN
MIM23560090Medicare PIN