Provider Demographics
NPI:1912934100
Name:REDDY, SRIKANTH KOTTAPALLY (MD)
Entity Type:Individual
Prefix:
First Name:SRIKANTH
Middle Name:KOTTAPALLY
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SRI
Other - Middle Name:K
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4802 S 109TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5822
Mailing Address - Country:US
Mailing Address - Phone:918-392-1400
Mailing Address - Fax:918-392-1488
Practice Address - Street 1:4812 S 109TH EAST AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5826
Practice Address - Country:US
Practice Address - Phone:918-392-1400
Practice Address - Fax:918-236-4587
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20733072081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK250012255OtherRAILROAD MEDICARE
OKP00216400OtherRAILROAD MEDICARE
OK100173420CMedicaid
OKP00216400OtherRAILROAD MEDICARE
OK250012255OtherRAILROAD MEDICARE
OK100173420CMedicaid