Provider Demographics
NPI:1780640714
Name:REDDY, KAKUTURU LAKSHMINARASA (MD)
Entity Type:Individual
Prefix:
First Name:KAKUTURU
Middle Name:LAKSHMINARASA
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 1:5767 49TH ST N
Mailing Address - Street 2:STE A
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2107
Mailing Address - Country:US
Mailing Address - Phone:727-433-4299
Mailing Address - Fax:727-443-0255
Practice Address - Street 1:5767 49TH ST N
Practice Address - Street 2:STE A
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2107
Practice Address - Country:US
Practice Address - Phone:727-433-4299
Practice Address - Fax:727-443-0255
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036319207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2905293OtherUNITED HEALTHCARE
3642571004OtherCIGNA
4490466OtherAETNA PPO
110079370OtherRR MEDICARE
2064670OtherAETNA HMO
41175OtherBCBS
D54716Medicare UPIN
4490466OtherAETNA PPO