Provider Demographics
NPI:1750365300
Name:SOLIPURAM, PRAVEENA REDDY (MD)
Entity type:Individual
Prefix:
First Name:PRAVEENA
Middle Name:REDDY
Last Name:SOLIPURAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7951 E MAPLEWOOD AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4723
Mailing Address - Country:US
Mailing Address - Phone:303-930-7800
Mailing Address - Fax:303-930-7860
Practice Address - Street 1:8820 HURON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-6805
Practice Address - Country:US
Practice Address - Phone:303-386-7622
Practice Address - Fax:303-427-6800
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO40775207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11801824Medicaid
I33456Medicare UPIN
COC802292Medicare PIN