Provider Demographics
NPI:1366416414
Name:REDDY, REBECCA H (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:H
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1861 N ROCK RD
Mailing Address - Street 2:STE 105
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-4200
Mailing Address - Country:US
Mailing Address - Phone:316-201-1202
Mailing Address - Fax:316-201-1251
Practice Address - Street 1:1861 N ROCK RD
Practice Address - Street 2:STE 105
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-4200
Practice Address - Country:US
Practice Address - Phone:316-201-1202
Practice Address - Fax:316-201-1251
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2013-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-29595208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100420630JMedicaid
KS100420630JMedicaid