Provider Demographics
NPI:1528259397
Name:KADIPI REDDY, VENKATA RAVI KIRAN (MD)
Entity type:Individual
Prefix:
First Name:VENKATA
Middle Name:RAVI KIRAN
Last Name:KADIPI REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2793 LINEVILLE ROAD
Mailing Address - Street 2:P O BOX 19070
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54307
Mailing Address - Country:US
Mailing Address - Phone:920-496-4700
Mailing Address - Fax:920-496-4704
Practice Address - Street 1:2793 LINEVILLE ROAD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54307
Practice Address - Country:US
Practice Address - Phone:920-496-4700
Practice Address - Fax:920-496-4704
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2007012349207Q00000X
WI54108-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI07028-0335Medicare PIN