Provider Demographics
NPI:1518068824
Name:REDDY, PADALA J (MD)
Entity Type:Individual
Prefix:DR
First Name:PADALA
Middle Name:J
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 1:114 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HILL CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67642-1722
Mailing Address - Country:US
Mailing Address - Phone:785-421-2191
Mailing Address - Fax:785-421-2195
Practice Address - Street 1:114 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:HILL CITY
Practice Address - State:KS
Practice Address - Zip Code:67642-1722
Practice Address - Country:US
Practice Address - Phone:785-421-2191
Practice Address - Fax:785-421-2195
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-15299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
111305OtherMEDICARE
KS100081770CMedicaid