Provider Demographics
NPI:1760472963
Name:REDDY, KALA GOPAL (MD)
Entity Type:Individual
Prefix:DR
First Name:KALA
Middle Name:GOPAL
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KALA
Other - Middle Name:GOPAL
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:961 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1318
Mailing Address - Country:US
Mailing Address - Phone:248-651-8889
Mailing Address - Fax:248-651-2228
Practice Address - Street 1:961 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1318
Practice Address - Country:US
Practice Address - Phone:248-651-8889
Practice Address - Fax:248-651-2228
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKR044107207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1606320361OtherBLUE CARE NETWORK
MI0636484OtherBCN
MI1606320361OtherBCBS
MI1606364841OtherBC/BS
MIA78266OtherHAP
MI1606320361OtherBCBS
MI1606364841OtherBC/BS