Basic Information
| Provider Information | |||||||||
| NPI: | 1053358226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDDY | ||||||||
| FirstName: | SURESH | ||||||||
| MiddleName: | KATAPALLI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2758 | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507042758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192355390 | ||||||||
| FaxNumber: | 3192355607 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 E TOWER PARK DR | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507019330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192345990 | ||||||||
| FaxNumber: | 3192345994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 02/16/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 27141 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 41999 | 01 | IA | WELLMARK INS PLAN | OTHER | 421417307B2 | 01 | IA | JOHN DEERE HEALTH INS PLN | OTHER | 1281378 | 05 | IA | MEDICAID |