Provider Demographics
NPI:1770692360
Name:REDDY, ADHIKARI M (MD)
Entity type:Individual
Prefix:DR
First Name:ADHIKARI
Middle Name:M
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:620 S MADISON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-7273
Mailing Address - Country:US
Mailing Address - Phone:580-234-2117
Mailing Address - Fax:
Practice Address - Street 1:620 S MADISON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-7273
Practice Address - Country:US
Practice Address - Phone:580-234-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK133232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK13000232OtherRAILROAD MEDICARE
OK13000232OtherRAILROAD MEDICARE