Provider Demographics
NPI:1841458106
Name:EDUNURI, KRISHNA KISHORE REDDY (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:KISHORE REDDY
Last Name:EDUNURI
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 DEPT
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-0021
Mailing Address - Country:US
Mailing Address - Phone:906-225-4821
Mailing Address - Fax:906-225-4537
Practice Address - Street 1:1635 N GEORGE MASON DR STE 155
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3604
Practice Address - Country:US
Practice Address - Phone:703-717-7652
Practice Address - Fax:703-717-7654
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092409207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1841458106Medicaid
MI0M03300052Medicare PIN