Provider Demographics
NPI:1558749218
Name:BUSIREDDY, KIRAN KUMAR REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:KUMAR REDDY
Last Name:BUSIREDDY
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 1:2665 HOWARD CMNS
Mailing Address - Street 2:APT 13
Mailing Address - City:HOWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54313-9379
Mailing Address - Country:US
Mailing Address - Phone:253-397-9411
Mailing Address - Fax:
Practice Address - Street 1:601 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2128
Practice Address - Country:US
Practice Address - Phone:402-449-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI76426-202085R0202X
TN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program