Provider Demographics
NPI:1932161155
Name:REDDY, PAVAN S (MD)
Entity Type:Individual
Prefix:
First Name:PAVAN
Middle Name:S
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 N EMPORIA ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3729
Mailing Address - Country:US
Mailing Address - Phone:316-262-4467
Mailing Address - Fax:316-262-2304
Practice Address - Street 1:818 N EMPORIA ST
Practice Address - Street 2:SUITE 403
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3729
Practice Address - Country:US
Practice Address - Phone:316-262-4467
Practice Address - Fax:316-262-0706
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0429403207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1286700004OtherDMERC REGION 1
KS1286700002OtherDMERC REGION 1
KS1286700007OtherDMERC REGION 1
KS1286700009OtherDMERC REGION 1
KS1286700003OtherDMERC REGION 1
KS12867010010OtherDMERC REGION 1
KS1286700012OtherDMERC REGION 1
KS1286700011OtherDMERC REGION 1
KS1286700013OtherDMERC REGION 1
KS1286700008OtherDMERC REGION 1
KS1286700006OtherDMERC REGION 1
KS100403380CMedicaid
KS1286700005OtherDMERC REGION 1
KS1286700015OtherDMERC REGION 1
KS1286700006OtherDMERC REGION 1
KS1286700012OtherDMERC REGION 1