Provider Demographics
NPI:1558377788
Name:REDDY, RAHUL KANDADA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:KANDADA
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:1850 BLUEGRASS AVE
Practice Address - Street 2:HIPS
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1161
Practice Address - Country:US
Practice Address - Phone:502-367-3360
Practice Address - Fax:502-367-3365
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY39661207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201076900Medicaid
KY7100004060Medicaid
KY7100004060Medicaid
KYK029202Medicare PIN