Provider Demographics
NPI:1780800326
Name:ACHUTHA N. REDDY, M.D., P. A.
Entity type:Organization
Organization Name:ACHUTHA N. REDDY, M.D., P. A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ACHUTHA
Authorized Official - Middle Name:NAGIREDDY
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-832-0277
Mailing Address - Street 1:1871 W 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-2104
Mailing Address - Country:US
Mailing Address - Phone:316-832-0277
Mailing Address - Fax:316-838-5658
Practice Address - Street 1:1871 W 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2104
Practice Address - Country:US
Practice Address - Phone:316-832-0277
Practice Address - Fax:316-838-5658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-283762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100427030DMedicaid