Provider Demographics
NPI:1750332151
Name:REDDY, PRATAP KONUDULLA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRATAP
Middle Name:KONUDULLA
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6525 FRANCE AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2148
Mailing Address - Country:US
Mailing Address - Phone:952-927-6501
Mailing Address - Fax:952-653-1435
Practice Address - Street 1:6525 FRANCE AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2148
Practice Address - Country:US
Practice Address - Phone:952-927-6501
Practice Address - Fax:952-653-1435
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN25234208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN544563900Medicaid
MNA95780Medicare UPIN
MN340000483Medicare ID - Type Unspecified