Provider Demographics
NPI:1841230117
Name:KAKULAVARAM, NALINI REDDY (MD)
Entity Type:Individual
Prefix:
First Name:NALINI
Middle Name:REDDY
Last Name:KAKULAVARAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NALINI(NANCY)
Other - Middle Name:REDDY
Other - Last Name:KAKULAVARAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1901 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-3010
Mailing Address - Country:US
Mailing Address - Phone:620-251-2333
Mailing Address - Fax:620-251-0548
Practice Address - Street 1:1901 W 4TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3010
Practice Address - Country:US
Practice Address - Phone:620-251-2333
Practice Address - Fax:620-251-0548
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24811207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000058631OtherBLUCOSS BLUE SHIELD
KS058631Medicare ID - Type UnspecifiedMEDICARE
KSF35233Medicare UPIN