Provider Demographics
NPI:1750109914
Name:KUNNURU, SUPREETH KUMAR REDDY
Entity type:Individual
Prefix:
First Name:SUPREETH KUMAR REDDY
Middle Name:
Last Name:KUNNURU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:OCHSNER CLINIC FOUNDATION
Mailing Address - Street 2:1514 JEFFERSON HIGHWAY
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121
Mailing Address - Country:US
Mailing Address - Phone:504-842-3260
Mailing Address - Fax:
Practice Address - Street 1:OCHSNER CLINIC FOUNDATION
Practice Address - Street 2:1514 JEFFERSON HIGHWAY
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121
Practice Address - Country:US
Practice Address - Phone:504-842-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343357390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program