Provider Demographics
NPI:1174582233
Name:REDDY, SANTHOSH K (MD)
Entity type:Individual
Prefix:
First Name:SANTHOSH
Middle Name:K
Last Name:REDDY
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 1:970 N ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-2121
Mailing Address - Country:US
Mailing Address - Phone:225-383-6363
Mailing Address - Fax:225-383-6367
Practice Address - Street 1:970 N ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-2121
Practice Address - Country:US
Practice Address - Phone:225-383-6363
Practice Address - Fax:225-383-6367
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09019R207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALB30021Medicare UPIN