Provider Demographics
NPI:1366467714
Name:REDDY, KURAPATI BHASKAR (MD, DPM)
Entity type:Individual
Prefix:DR
First Name:KURAPATI
Middle Name:BHASKAR
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD, DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 SOUTHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-5900
Mailing Address - Country:US
Mailing Address - Phone:715-834-2751
Mailing Address - Fax:715-743-5209
Practice Address - Street 1:517 COURT ST RM 503
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-1976
Practice Address - Country:US
Practice Address - Phone:715-743-5192
Practice Address - Fax:715-743-5209
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11662084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30565600Medicaid
WIB85183Medicare UPIN