Provider Demographics
NPI:1942345186
Name:REDDIAR, VENUGOPAL S (MD)
Entity Type:Individual
Prefix:DR
First Name:VENUGOPAL
Middle Name:S
Last Name:REDDIAR
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 1:209 HOLIDAY RD APT 213
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1133
Mailing Address - Country:US
Mailing Address - Phone:319-341-5723
Mailing Address - Fax:
Practice Address - Street 1:520 10TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1923
Practice Address - Country:US
Practice Address - Phone:319-358-2406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30888207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine