Provider Demographics
NPI:1346552189
Name:ANNAPUREDDY, AMARNATH R
Entity type:Individual
Prefix:
First Name:AMARNATH
Middle Name:R
Last Name:ANNAPUREDDY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S SADDLE CREEK RD # LTC8732
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-1423
Mailing Address - Country:US
Mailing Address - Phone:402-559-5151
Mailing Address - Fax:
Practice Address - Street 1:601 S SADDLE CREEK RD # LTC8732
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-1423
Practice Address - Country:US
Practice Address - Phone:402-559-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE36359207RI0011X
CT065495-RES390200000X
CT54490207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500484Medicaid