Provider Demographics
NPI:1215935812
Name:REDDY, SUGUNA V (MD)
Entity type:Individual
Prefix:MRS
First Name:SUGUNA
Middle Name:V
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SUGUNA
Other - Middle Name:
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 W CENTRAL AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2184
Mailing Address - Country:US
Mailing Address - Phone:316-321-7550
Mailing Address - Fax:316-321-1404
Practice Address - Street 1:700 W CENTRAL AVE
Practice Address - Street 2:STE 108
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2184
Practice Address - Country:US
Practice Address - Phone:316-321-7550
Practice Address - Fax:316-321-1404
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18326208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100194400AMedicaid
KS617610OtherHEALTHWAVE
KA1403Medicare PIN
KS617610OtherHEALTHWAVE