Provider Demographics
NPI:1649223447
Name:KEESARA, RAMESH REDDY (MD)
Entity Type:Individual
Prefix:MR
First Name:RAMESH
Middle Name:REDDY
Last Name:KEESARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:187 W MAIN ST
Mailing Address - Street 2:PO BOX 127
Mailing Address - City:DECATURVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38329
Mailing Address - Country:US
Mailing Address - Phone:731-852-2761
Mailing Address - Fax:731-852-2781
Practice Address - Street 1:187 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DECATURVILLE
Practice Address - State:TN
Practice Address - Zip Code:38329
Practice Address - Country:US
Practice Address - Phone:731-852-2761
Practice Address - Fax:731-852-2781
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12891207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3183218Medicaid
TN0001364OtherBCBS OF TN PIN
TN0001364OtherBCBS OF TN PIN
TN3183218Medicaid