Provider Demographics
NPI:1982694436
Name:REDDY, VIKRAM K (MD)
Entity Type:Individual
Prefix:DR
First Name:VIKRAM
Middle Name:K
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:VIKRAM
Other - Middle Name:K
Other - Last Name:REDDY-REDDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1423 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3226
Mailing Address - Country:US
Mailing Address - Phone:530-896-7455
Mailing Address - Fax:530-896-1730
Practice Address - Street 1:1531 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3310
Practice Address - Country:US
Practice Address - Phone:530-896-7455
Practice Address - Fax:530-896-1730
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055938A207R00000X
CAC52488208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200368910Medicaid
IN190440Medicare ID - Type Unspecified
IN200368910Medicaid
INH61198Medicare UPIN