Provider Demographics
NPI:1518008440
Name:Y K REDDY MD APMC ASTHMA AND ALLERGY CENTER
Entity Type:Organization
Organization Name:Y K REDDY MD APMC ASTHMA AND ALLERGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMALAKAR
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:YATURU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-549-3500
Mailing Address - Street 1:PO BOX 5189
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71171-5189
Mailing Address - Country:US
Mailing Address - Phone:318-549-3500
Mailing Address - Fax:
Practice Address - Street 1:2910 SHED RD
Practice Address - Street 2:SUITE A
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-3154
Practice Address - Country:US
Practice Address - Phone:318-549-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11407R207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1699624Medicaid
LA5H230Medicare ID - Type Unspecified
LA1699624Medicaid