Provider Demographics
NPI:1255325171
Name:REDDY, KUCHAKULLA NARASIMHA (M D)
Entity type:Individual
Prefix:
First Name:KUCHAKULLA
Middle Name:NARASIMHA
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 1:110 S WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3546
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:321-221-9454
Practice Address - Street 1:13275 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3984
Practice Address - Country:US
Practice Address - Phone:407-905-8827
Practice Address - Fax:407-654-4079
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66726174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375915600Medicaid
FL375915600Medicaid
FL25703XMedicare ID - Type Unspecified