Provider Demographics
NPI:1497142889
Name:KATHI, PRADEEP REDDY (MD)
Entity Type:Individual
Prefix:MR
First Name:PRADEEP
Middle Name:REDDY
Last Name:KATHI
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:PO BOX 26666
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:2400 UNSER BLVD SE STE 19100
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4740
Practice Address - Country:US
Practice Address - Phone:505-224-7000
Practice Address - Fax:313-745-4052
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2022-07-20
Deactivation Date:2015-12-03
Deactivation Code:
Reactivation Date:2016-01-06
Provider Licenses
StateLicense IDTaxonomies
NMMD2021-0943207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology