Provider Demographics
NPI:1952396277
Name:REGANTI, REDDY S (MD)
Entity Type:Individual
Prefix:
First Name:REDDY
Middle Name:S
Last Name:REGANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1225 S GEAR AVE
Mailing Address - Street 2:SUITE 152
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1691
Mailing Address - Country:US
Mailing Address - Phone:319-753-1220
Mailing Address - Fax:319-753-5464
Practice Address - Street 1:1225 S GEAR AVE
Practice Address - Street 2:SUITE 152
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1691
Practice Address - Country:US
Practice Address - Phone:319-753-1220
Practice Address - Fax:319-753-5464
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA229772085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA32196OtherCCA-BCBS OF IA PROV NUMB
IA23382OtherGRO-BCBS OF IA PROV NUMB
IA4213017Medicaid
IA3213017Medicaid
IA32196OtherCCA-BCBS OF IA PROV NUMB
IAI0875Medicare ID - Type UnspecifiedGRO MED PROV NUMBER
IA23382OtherGRO-BCBS OF IA PROV NUMB