Provider Demographics
NPI:1184617938
Name:REDDY, VISHNU P (M D)
Entity type:Individual
Prefix:
First Name:VISHNU
Middle Name:P
Last Name:REDDY
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3256 S PINE AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6618
Mailing Address - Country:US
Mailing Address - Phone:352-401-1919
Mailing Address - Fax:352-401-1870
Practice Address - Street 1:3256 S PINE AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6618
Practice Address - Country:US
Practice Address - Phone:352-401-1919
Practice Address - Fax:352-401-1870
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257757700Medicaid
FL46716YMedicare ID - Type Unspecified
FLG18499Medicare UPIN