Provider Demographics
NPI:1760547293
Name:REDDY, CHEEPULOTI HANUMANTHA (MD)
Entity Type:Individual
Prefix:
First Name:CHEEPULOTI
Middle Name:HANUMANTHA
Last Name:REDDY
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 1:189 WHIPOORWILL DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-9777
Mailing Address - Country:US
Mailing Address - Phone:270-726-4488
Mailing Address - Fax:
Practice Address - Street 1:189 WHIPOORWILL DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-9777
Practice Address - Country:US
Practice Address - Phone:270-726-4488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY304212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64304215Medicaid
KY64304215Medicaid
KY1580501Medicare ID - Type UnspecifiedKENTUCKY MEDICARE