Provider Demographics
NPI:1023067881
Name:LAKKIREDDY, DHANUNJAYA (MD)
Entity type:Individual
Prefix:DR
First Name:DHANUNJAYA
Middle Name:
Last Name:LAKKIREDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 NW 62ND TER
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-2411
Mailing Address - Country:US
Mailing Address - Phone:816-584-8884
Mailing Address - Fax:913-945-9612
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:SUITE#G600
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-9600
Practice Address - Fax:913-588-9770
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29029207RC0000X, 207RC0001X, 207RC0001X
MO117378207RC0000X, 207RC0001X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS105678OtherBCBS KS OUTREACH CLINICS
KS200387770BMedicaid
KS200387770AMedicaid
MO203747605Medicaid
MO37126012OtherBCBS KC
MO038E120EMedicare PIN
H39593Medicare UPIN
MO203747605Medicaid
KS200387770BMedicaid
MO37126012OtherBCBS KC
MOP00323054Medicare PIN
KSP00365888Medicare PIN