1972733541 NPI number — DR. KRANTHI KIRAN REDDY RAGIREDDY M.D

Table of content: DR. KRANTHI KIRAN REDDY RAGIREDDY M.D (NPI 1972733541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972733541 NPI number — DR. KRANTHI KIRAN REDDY RAGIREDDY M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAGIREDDY
Provider First Name:
KRANTHI KIRAN
Provider Middle Name:
REDDY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972733541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
304 TANGER DR
Provider Second Line Business Mailing Address:
STE 221
Provider Business Mailing Address City Name:
TERRELL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-535-6493
Provider Business Mailing Address Fax Number:
972-551-1418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 TANGER DR
Provider Second Line Business Practice Location Address:
STE 221
Provider Business Practice Location Address City Name:
TERRELL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-535-6493
Provider Business Practice Location Address Fax Number:
972-551-1418
Provider Enumeration Date:
07/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  Q7597 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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