Provider Demographics
NPI:1841244514
Name:REDDY, KALA (MD)
Entity Type:Individual
Prefix:MRS
First Name:KALA
Middle Name:
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 N CASEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PIGEON
Mailing Address - State:MI
Mailing Address - Zip Code:48755-9704
Mailing Address - Country:US
Mailing Address - Phone:989-453-5210
Mailing Address - Fax:
Practice Address - Street 1:168 N CASEVILLE RD
Practice Address - Street 2:
Practice Address - City:PIGEON
Practice Address - State:MI
Practice Address - Zip Code:48755-9704
Practice Address - Country:US
Practice Address - Phone:989-453-2141
Practice Address - Fax:989-453-4450
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060834208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI100018OtherSHN HOSPITAL GLHP
MI2994767Medicaid
MI3162094Medicaid
MI2994767Medicaid
MI233977Medicare Oscar/Certification
MIF63730Medicare UPIN
MI0C26017009Medicare PIN